Provider Demographics
NPI:1386177798
Name:SOUTHEAST GEORGIA HEALTH SERVICES, L.L.C.
Entity type:Organization
Organization Name:SOUTHEAST GEORGIA HEALTH SERVICES, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-287-2500
Mailing Address - Street 1:2500 SATILLA PKWY
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-8852
Mailing Address - Country:US
Mailing Address - Phone:912-283-3030
Mailing Address - Fax:912-287-2505
Practice Address - Street 1:2500 SATILLA PKWY
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-8852
Practice Address - Country:US
Practice Address - Phone:912-283-3030
Practice Address - Fax:912-287-2505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST GEORGIA HEALTH SERVICES, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-04
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
11T0003Medicare Oscar/Certification