Provider Demographics
NPI:1760436810
Name:COLISEUM MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:COLISEUM MEDICAL CENTER, LLC
Other - Org Name:PIEDMONT MACON 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 1:340 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3838
Mailing Address - Country:US
Mailing Address - Phone:478-741-1355
Mailing Address - Fax:478-742-1247
Practice Address - Street 1:340 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217
Practice Address - Country:US
Practice Address - Phone:478-741-1355
Practice Address - Fax:478-742-1247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLISEUM MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-22
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
166206000OtherDEPT OF LABOR
GA3521OtherBLUE CROSS
166206000OtherDEPT OF LABOR
114015Medicare Oscar/Certification