Provider Demographics
NPI:1114923406
Name:THE MEDICAL CENTER OF PEACH COUNTY, INC
Entity type:Organization
Organization Name:THE MEDICAL CENTER OF PEACH COUNTY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHREWBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-633-1452
Mailing Address - Street 1:1960 HWY 247 CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-5663
Mailing Address - Country:US
Mailing Address - Phone:478-654-2000
Mailing Address - Fax:478-654-2001
Practice Address - Street 1:1960 HWY 247 CONNECTOR
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-5663
Practice Address - Country:US
Practice Address - Phone:478-654-2000
Practice Address - Fax:478-654-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111-136282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00001449AMedicaid
GA00001449AMedicaid
GA111310Medicare Oscar/Certification