Provider Demographics
NPI:1861628752
Name:HUGHSTON HOSPITAL, INC.
Entity Type:Organization
Organization Name:HUGHSTON HOSPITAL, INC.
Other - Org Name:NORTHSIDE 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:CLIFFORD
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-271-3401
Mailing Address - Street 1:2727 PACES FERRY RD SE STE 2-920
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4053
Mailing Address - Country:US
Mailing Address - Phone:470-271-3414
Mailing Address - Fax:770-319-2180
Practice Address - Street 1:100 FRIST CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3578
Practice Address - Country:US
Practice Address - Phone:706-494-2101
Practice Address - Fax:706-494-2446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUGHSTON HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-05
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
11T200Medicare Oscar/Certification