Provider Demographics
NPI:1982658944
Name:PALMYRA PARK HOSPITAL, INC.
Entity Type:Organization
Organization Name:PALMYRA PARK HOSPITAL, INC.
Other - Org Name:PALMYRA MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-434-2100
Mailing Address - Street 1:PO BOX 1908
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-1908
Mailing Address - Country:US
Mailing Address - Phone:912-434-2000
Mailing Address - Fax:912-434-2563
Practice Address - Street 1:2000 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1528
Practice Address - Country:US
Practice Address - Phone:912-434-2000
Practice Address - Fax:912-434-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC11519BMedicaid