Provider Demographics
NPI:1609820661
Name:COLUMBIA POLK GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:COLUMBIA POLK GENERAL HOSPITAL, INC.
Other - Org Name:POLK MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-748-8506
Mailing Address - Street 1:424 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-2644
Mailing Address - Country:US
Mailing Address - Phone:770-748-2500
Mailing Address - Fax:770-749-9904
Practice Address - Street 1:424 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-2644
Practice Address - Country:US
Practice Address - Phone:770-748-2500
Practice Address - Fax:770-749-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
11Z330Medicare Oscar/Certification