Provider Demographics
NPI:1285961250
Name:MACON COUNTY MEDICAL CENTER, INC DBA FLINT RIVER COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:MACON COUNTY MEDICAL CENTER, INC DBA FLINT RIVER COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUPP
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:478-472-3246
Mailing Address - Street 1:509 SUMTER ST
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:GA
Mailing Address - Zip Code:31063-1733
Mailing Address - Country:US
Mailing Address - Phone:478-472-2321
Mailing Address - Fax:478-472-2672
Practice Address - Street 1:502 SUMTER ST
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:GA
Practice Address - Zip Code:31063-1733
Practice Address - Country:US
Practice Address - Phone:478-472-7429
Practice Address - Fax:478-472-5142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID NUMBER