Provider Demographics
NPI:1811940976
Name:MACON NORTHSIDE HOSPITAL, LLC
Entity type:Organization
Organization Name:MACON NORTHSIDE HOSPITAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP GOVERNMENT REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-271-3401
Mailing Address - Street 1:400 CHARTER BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4831
Mailing Address - Country:US
Mailing Address - Phone:478-757-5992
Mailing Address - Fax:478-757-5995
Practice Address - Street 1:400 CHARTER BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4831
Practice Address - Country:US
Practice Address - Phone:478-757-5992
Practice Address - Fax:478-757-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02718909Medicaid
FL911882900Medicaid
GA3525OtherBLUE CROSS
NY141351CFMedicaid
MI025706Medicaid
166206700OtherDEPT OF LABOR
LA1729221Medicaid
GA00295358AMedicaid
WI82604500Medicaid
LA1729221Medicaid