Provider Demographics
NPI:1457388571
Name:NORTHEAST GEORGIA MEDICAL CENTER., INC.
Entity Type:Organization
Organization Name:NORTHEAST GEORGIA MEDICAL CENTER., INC.
Other - Org Name:HOSPICE OF NORTHEAST GEORGIA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-219-3562
Mailing Address - Street 1:2150 LIMESTONE PKWY
Mailing Address - Street 2:SUITE 222
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2567
Mailing Address - Country:US
Mailing Address - Phone:770-219-8888
Mailing Address - Fax:770-219-6694
Practice Address - Street 1:2150 LIMESTONE PKWY
Practice Address - Street 2:SUITE 222
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2567
Practice Address - Country:US
Practice Address - Phone:770-219-8888
Practice Address - Fax:770-219-6694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST GEORGIA MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-26
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251G00000X
315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00371324AMedicaid
GA111514Medicare Oscar/Certification
GA111514Medicare PIN
GA111514Medicare ID - Type UnspecifiedMEDICARE
GA00371324AMedicaid