Provider Demographics
NPI:1780063552
Name:REDMOND PARK
Entity type:Organization
Organization Name:REDMOND PARK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF FINANCIAL MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-802-3297
Mailing Address - Street 1:501 REDMOND RD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1415
Mailing Address - Country:US
Mailing Address - Phone:706-802-3297
Mailing Address - Fax:706-802-3887
Practice Address - Street 1:501 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1415
Practice Address - Country:US
Practice Address - Phone:706-802-3297
Practice Address - Fax:706-802-3887
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDMOND REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13565523503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport