Provider Demographics
NPI:1588646251
Name:WHEELER COUNTY HOSPITAL
Entity Type:Organization
Organization Name:WHEELER COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-523-5113
Mailing Address - Street 1:111 N THIRD ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30428-2301
Mailing Address - Country:US
Mailing Address - Phone:912-523-5113
Mailing Address - Fax:912-523-5910
Practice Address - Street 1:111 N THIRD ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30428-2301
Practice Address - Country:US
Practice Address - Phone:912-523-5113
Practice Address - Fax:912-523-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Not Answered282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00002076AMedicaid
GA11Z321Medicare ID - Type Unspecified
GA00002076AMedicaid