Provider Demographics
NPI:1790992352
Name:CRISP REGIONAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:CRISP REGIONAL HOSPITAL, INC.
Other - Org Name:WARWICK HEALTH CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PHYSICIAN PRACTICES
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-271-4676
Mailing Address - Street 1:135 DOGWOOD ST SW
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31796-5568
Mailing Address - Country:US
Mailing Address - Phone:229-535-4567
Mailing Address - Fax:229-535-6556
Practice Address - Street 1:135 DOGWOOD ST SW
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:GA
Practice Address - Zip Code:31796-5568
Practice Address - Country:US
Practice Address - Phone:229-535-4567
Practice Address - Fax:229-535-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000514FMedicaid
GA00000514FMedicaid