Provider Demographics
NPI:1740541929
Name:BURKE COUNTY HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:BURKE COUNTY HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENT
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:706-554-4435
Mailing Address - Fax:706-554-4854
Practice Address - Street 1:351 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-9686
Practice Address - Country:US
Practice Address - Phone:706-554-4435
Practice Address - Fax:706-554-4854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURKE COUNTY HOSPITAL AUTHORITY D/B/A BURKE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-04
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA201092275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11U113Medicare Oscar/Certification