Basic Information
| Provider Information | |||||||||
| NPI: | 1649402934 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BCH MEDICAL INVESTORS, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | BERRIEN COUNTY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 E MCPHERSON AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316392326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2295437314 | ||||||||
| FaxNumber: | 2295431724 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 E MCPHERSON AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316392326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2295437314 | ||||||||
| FaxNumber: | 2295431724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2009 | ||||||||
| LastUpdateDate: | 01/11/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FLETCHER | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2295437314 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | L & J ASSOCIATES, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | GA 2009-006 | GA | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 00000173A | 05 | GA | MEDICAID |