Provider Demographics
NPI:1336163096
Name:COOPERATIVE HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:COOPERATIVE HEALTHCARE SERVICES, INC.
Other - Org Name:SOUTHEAST GEORGIA HEALTH SYSTEM ENT SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SCHERNECK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:912-466-7049
Mailing Address - Street 1:2415 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4722
Mailing Address - Country:US
Mailing Address - Phone:912-466-7000
Mailing Address - Fax:712-466-5091
Practice Address - Street 1:2916 GLYNN AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4844
Practice Address - Country:US
Practice Address - Phone:912-265-2573
Practice Address - Fax:912-262-0795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063-316261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
111058ASCBMedicare ID - Type Unspecified