Basic Information
| Provider Information | |||||||||
| NPI: | 1073136990 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MIDDLE FLINT AREA COMMUNITY SERVICE BOARD | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1348 | ||||||||
| Address2: | |||||||||
| City: | AMERICUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317091348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298155454 | ||||||||
| FaxNumber: | 2298156606 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 W FURLOW ST | ||||||||
| Address2: | |||||||||
| City: | AMERICUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317094110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298155454 | ||||||||
| FaxNumber: | 2298156606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2020 | ||||||||
| LastUpdateDate: | 05/27/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JORDAN | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE MANAGEMENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2298155454 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MIDDLE FLINT AREA COMMUNITY SERVICE BOARD | ||||||||
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| NPICertificationDate: | 05/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | Y | Agencies | Public Health or Welfare |
No ID Information.