Provider Demographics
NPI:1306100342
Name:CYPRESS MEDICAL, LLC
Entity type:Organization
Organization Name:CYPRESS MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-839-2810
Mailing Address - Street 1:PO BOX 1957
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-1957
Mailing Address - Country:US
Mailing Address - Phone:912-839-2810
Mailing Address - Fax:912-839-2808
Practice Address - Street 1:1499 FAIR RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1683
Practice Address - Country:US
Practice Address - Phone:912-839-2810
Practice Address - Fax:912-839-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55863208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129950AMedicaid
GA202G700747OtherMEDICARE PTAN