Provider Demographics
NPI:1821308834
Name:JENKINS COUNTY HOSPITAL LLC
Entity Type:Organization
Organization Name:JENKINS COUNTY HOSPITAL LLC
Other - Org Name:OPTIM SURGICAL ASSOCIATES - STATESBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLEINPETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-644-5300
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 1:16915 HIGHWAY 67
Practice Address - Street 2:SUITE A
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5819
Practice Address - Country:US
Practice Address - Phone:912-681-2500
Practice Address - Fax:912-644-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-12
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty