Provider Demographics
NPI:1649224486
Name:CARTERSVILLE MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:CARTERSVILLE MEDICAL CENTER, LLC
Other - Org Name:PIEDMONT CARTERSVILLE 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 1:960 JOE FRANK HARRIS PKWY SE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2129
Mailing Address - Country:US
Mailing Address - Phone:770-382-1530
Mailing Address - Fax:770-606-2127
Practice Address - Street 1:960 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2129
Practice Address - Country:US
Practice Address - Phone:770-382-1530
Practice Address - Fax:770-606-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC11284BMedicaid