Provider Demographics
NPI:1356344915
Name:CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY
Entity type:Organization
Organization Name:CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-756-9180
Mailing Address - Street 1:4800 48TH ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3666
Mailing Address - Country:US
Mailing Address - Phone:334-756-9180
Mailing Address - Fax:334-756-6678
Practice Address - Street 1:4800 48TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3666
Practice Address - Country:US
Practice Address - Phone:334-756-9180
Practice Address - Fax:334-756-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10478282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00061773AMedicaid
AL1912929068OtherFAGAN NPI
ALHOS0025HMedicaid
ALPEC0025HMedicaid
AL529929850Medicaid
AL010076OtherBCBS HOSP PROVIDER #
AL010076OtherBCBS HOSP PROVIDER #
ALHOS0025HMedicaid