Basic Information
| Provider Information | |||||||||
| NPI: | 1053672527 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BURKE COUNTY HOSPITAL AUTHORITY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | BURKE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 351 S LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308309686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065544435 | ||||||||
| FaxNumber: | 7065544854 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 S LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065544435 | ||||||||
| FaxNumber: | 7065544854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2012 | ||||||||
| LastUpdateDate: | 06/18/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STEINER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7064372650 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 017-563 | GA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 000000283A | 05 | GA | MEDICAID |