Basic Information
| Provider Information | |||||||||
| NPI: | 1669004966 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EFFINGHAM HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 459 HIGHWAY 119 S | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313293021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127540175 | ||||||||
| FaxNumber: | 9127542570 | ||||||||
| Practice Location | |||||||||
| Address1: | 459 HIGHWAY 119 S STE A | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313293021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127541097 | ||||||||
| FaxNumber: | 9127540186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2020 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | ALIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9127540175 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EFFINGHAM HOSPITAL, INC. | ||||||||
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| NPICertificationDate: | 02/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.