Provider Demographics
NPI:1780880583
Name:WHEELER COUNTY HOSPITAL
Entity type:Organization
Organization Name:WHEELER COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-523-5113
Mailing Address - Street 1:111 NORTH 3RD STREET
Mailing Address - Street 2:P O BOX 398
Mailing Address - City:GLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30428
Mailing Address - Country:US
Mailing Address - Phone:912-523-5113
Mailing Address - Fax:912-523-5910
Practice Address - Street 1:111 NORTH 3RD STREET
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30428
Practice Address - Country:US
Practice Address - Phone:912-523-5113
Practice Address - Fax:912-523-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11Z321Medicare Oscar/Certification