Provider Demographics
NPI:1740272095
Name:DODGE COUNTY HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:DODGE COUNTY HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-448-4050
Mailing Address - Street 1:901 GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6784
Mailing Address - Country:US
Mailing Address - Phone:478-448-4435
Mailing Address - Fax:478-374-0337
Practice Address - Street 1:901 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6720
Practice Address - Country:US
Practice Address - Phone:478-448-4091
Practice Address - Fax:478-448-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000591BMedicaid
000875OtherBC
GA000000591AMedicaid
00139OtherBC
00139OtherBC
GA000000591BMedicaid