Provider Demographics
NPI:1700392438
Name:UPSON COUNTY HOSPITAL INC
Entity Type:Organization
Organization Name:UPSON COUNTY HOSPITAL INC
Other - Org Name:UPSON REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:TARRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-647-8111
Mailing Address - Street 1:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-0027
Mailing Address - Country:US
Mailing Address - Phone:706-647-8111
Mailing Address - Fax:706-647-4389
Practice Address - Street 1:206 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3402
Practice Address - Country:US
Practice Address - Phone:706-647-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003213614AMedicaid