Provider Demographics
NPI:1669004966
Name:EFFINGHAM HOSPITAL, INC.
Entity Type:Organization
Organization Name:EFFINGHAM HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-754-0175
Mailing Address - Street 1:459 HIGHWAY 119 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-3021
Mailing Address - Country:US
Mailing Address - Phone:912-754-0175
Mailing Address - Fax:912-754-2570
Practice Address - Street 1:459 HIGHWAY 119 S STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-3021
Practice Address - Country:US
Practice Address - Phone:912-754-1097
Practice Address - Fax:912-754-0186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EFFINGHAM HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty