Provider Demographics
NPI:1558339085
Name:HUTCHESON MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:HUTCHESON MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:FORGEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-858-2000
Mailing Address - Street 1:100 GROSS CRESCENT CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3643
Mailing Address - Country:US
Mailing Address - Phone:706-858-2000
Mailing Address - Fax:706-858-2732
Practice Address - Street 1:100 GROSS CRESCENT CIRCLE
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3643
Practice Address - Country:US
Practice Address - Phone:706-858-2000
Practice Address - Fax:706-858-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023522282N00000X
GA14609341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00001075AMedicaid
GA1000092OtherBLUE CROSS TENNESSEE
GA58600446402OtherJOHN DEERE
GA000134659AMedicaid
GA100042OtherBLUE CROSS GEORGIA
GA5000082OtherUNITED HEALTHCARE
GA5000082OtherUNITED HEALTHCARE
GA110004Medicare Oscar/Certification