Provider Demographics
NPI:1760460448
Name:PHOEBE WORTH MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:PHOEBE WORTH MEDICAL CENTER, INC
Other - Org Name:PHOEBE WORTH MEDICAL CENTER, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLYNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-777-4514
Mailing Address - Street 1:807 S ISABELLA ST
Mailing Address - Street 2:P.O. BOX 545
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-7554
Mailing Address - Country:US
Mailing Address - Phone:229-777-4514
Mailing Address - Fax:229-776-7062
Practice Address - Street 1:807 S ISABELLA ST
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-7554
Practice Address - Country:US
Practice Address - Phone:229-777-4514
Practice Address - Fax:229-776-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000490OtherBLUE CROSS
GA00002109SMedicaid
GA00002109SMedicaid