Provider Demographics
NPI:1629217799
Name:THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:THE BAXLEY AND APPLING COUNTY HOSPITAL AUTHORITY
Other - Org Name:APPLING OBSTETRICS AND GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-367-9841
Mailing Address - Street 1:PO BOX 2070
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31515-2070
Mailing Address - Country:US
Mailing Address - Phone:912-367-9841
Mailing Address - Fax:912-367-0436
Practice Address - Street 1:195 E TOLLISON ST
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0120
Practice Address - Country:US
Practice Address - Phone:912-367-0435
Practice Address - Fax:912-367-0436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLING HEALTHCARE SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-13
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001-502261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
118523Medicare Oscar/Certification