Basic Information
| Provider Information | |||||||||
| NPI: | 1770575003 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEADOWS REGIONAL MEDICAL CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE MEADOWS PARKWAY | ||||||||
| Address2: | |||||||||
| City: | VIDALIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125355555 | ||||||||
| FaxNumber: | 9125385351 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE MEADOWS PARKWAY | ||||||||
| Address2: | |||||||||
| City: | VIDALIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125355555 | ||||||||
| FaxNumber: | 9125385351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 01/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | O'STEEN | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9125358691 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 138-476 | GA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00001086A | 05 | GA | MEDICAID |