Basic Information
| Provider Information | |||||||||
| NPI: | 1609097617 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITALMD OF SPARTA, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 CAMDEN COPE | ||||||||
| Address2: | PO BOX 2087 | ||||||||
| City: | PEACHTREE CITY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302692455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783641422 | ||||||||
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| 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: | 05/01/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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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 | 207PE0004X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.