Provider Demographics
NPI:1013933944
Name:BURKE COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:BURKE COUNTY HOSPITAL AUTHORITY
Other - Org Name:BURKE MEDICAL CENTER HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:STEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-554-4435
Mailing Address - Street 1:351 S LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-9686
Mailing Address - Country:US
Mailing Address - Phone:706-437-2655
Mailing Address - Fax:706-544-4854
Practice Address - Street 1:311 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830
Practice Address - Country:US
Practice Address - Phone:706-554-2176
Practice Address - Fax:706-554-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7856207Q00000X, 261QR1300X
GA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00665959AMedicaid
GA00665959AMedicaid
GA113872Medicare ID - Type Unspecified