Provider Demographics
NPI:1851356349
Name:PHOEBE PUTNEY MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:PHOEBE PUTNEY MEMORIAL HOSPITAL, INC.
Other - Org Name:PHOEBE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-312-4068
Mailing Address - Street 1:320 FOUNDATION LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-5862
Mailing Address - Country:US
Mailing Address - Phone:229-312-7050
Mailing Address - Fax:229-312-7055
Practice Address - Street 1:320 FOUNDATION LN
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-5862
Practice Address - Country:US
Practice Address - Phone:229-312-7050
Practice Address - Fax:229-312-7055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOEBE PUTNEY MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-19
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000466001AMedicaid
GA000466001AMedicaid