Provider Demographics
NPI:1053388256
Name:HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY
Entity type:Organization
Organization Name:HOSPITAL AUTHORITY OF THE CITY OF BAINBRIDGE AND DECATUR COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRCLOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-246-8211
Mailing Address - Street 1:1500 E SHOTWELL ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4256
Mailing Address - Country:US
Mailing Address - Phone:229-246-3500
Mailing Address - Fax:229-246-8142
Practice Address - Street 1:1500 E SHOTWELL ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4256
Practice Address - Country:US
Practice Address - Phone:229-246-3500
Practice Address - Fax:229-246-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 275N00000X
GA43-112282N00000X
GA1-043-500314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00001262TMedicaid
GA00001262SMedicaid
GA00141919AMedicaid
GA00001262AMedicaid
GA000307OtherBLUE CROSS BLUE SHIELD
GA00001262TMedicaid
GA00141919AMedicaid