Provider Demographics
NPI:1598719643
Name:COLISEUM MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:COLISEUM MEDICAL CENTER, LLC
Other - Org Name:PIEDMONT MACON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP GOVERNMENT REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-271-3401
Mailing Address - Street 1:350 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3838
Mailing Address - Country:US
Mailing Address - Phone:478-765-7000
Mailing Address - Fax:478-742-1247
Practice Address - Street 1:C/O COLISEUM HEALTH SYSTEM
Practice Address - Street 2:350 HOSPITAL DRIVE
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217
Practice Address - Country:US
Practice Address - Phone:478-765-7000
Practice Address - Fax:478-742-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000459AMedicaid
GA3522OtherBLUE CROSS
MI25706Medicaid
FL912181100Medicaid
NJ4103009Medicaid
166202500OtherDEPT OF LABOR
IN200461450AMedicaid
ALHOS0164NMedicaid
LA1729302Medicaid
FL203375OtherFLORIDA MEDICAID HMO
110164Medicare Oscar/Certification