Provider Demographics
NPI:1992180087
Name:I V CARE OF MIDDLE GEORGIA INC
Entity Type:Organization
Organization Name:I V CARE OF MIDDLE GEORGIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INTAKE & REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:T
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-743-3033
Mailing Address - Street 1:718 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6736
Mailing Address - Country:US
Mailing Address - Phone:478-374-6662
Mailing Address - Fax:478-374-6663
Practice Address - Street 1:6001 RIVER RD
Practice Address - Street 2:SUITE 411
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-689-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:I V CARE OF MIDDLE GEORGIA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-30
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy