Basic Information
| Provider Information | |||||||||
| NPI: | 1225218837 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITALMD OF SPARTA-IP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 WESTPARK DR | ||||||||
| Address2: | SUITE 325 | ||||||||
| City: | PEACHTREE CITY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302693534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706326981 | ||||||||
| FaxNumber: | 7706318473 | ||||||||
| Practice Location | |||||||||
| Address1: | 818 E BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622861820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184432177 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2007 | ||||||||
| LastUpdateDate: | 12/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | BURNETTE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6783641422 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.