Provider Demographics
NPI:1215959341
Name:TY COBB HEALTHCARE SYSTEM, INC.
Entity type:Organization
Organization Name:TY COBB HEALTHCARE SYSTEM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-356-7456
Mailing Address - Street 1:29 CLEAR CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:LAVONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30553-4172
Mailing Address - Country:US
Mailing Address - Phone:877-485-5718
Mailing Address - Fax:706-356-7403
Practice Address - Street 1:29 CLEAR CREEK PKWY
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-4172
Practice Address - Country:US
Practice Address - Phone:877-485-5718
Practice Address - Fax:706-356-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52448230OtherBCBS OF GEORGIA
GA000059562CMedicaid
GA000059562CMedicaid