Provider Demographics
NPI:1679907315
Name:TATTNALL HOSPITAL COMPANY, LLC
Entity Type:Organization
Organization Name:TATTNALL HOSPITAL COMPANY, LLC
Other - Org Name:OPTIM PRIMARY CARE- DARIEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY OF COMM. HOSP.HOLD. CO.,
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUENTHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-627-8427
Mailing Address - Street 1:210 E DERENNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6736
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:1101 NORTH WAY
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:GA
Practice Address - Zip Code:31305-9141
Practice Address - Country:US
Practice Address - Phone:912-644-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TATTNALL HOSPITAL COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-29
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health