Provider Demographics
NPI:1992743975
Name:NATIONAL HEALTHCARE CENTER OF FT OGLETHORPE LTD
Entity type:Organization
Organization Name:NATIONAL HEALTHCARE CENTER OF FT OGLETHORPE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-523-2473
Mailing Address - Street 1:2403 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4033
Mailing Address - Country:US
Mailing Address - Phone:706-866-7700
Mailing Address - Fax:
Practice Address - Street 1:2403 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4033
Practice Address - Country:US
Practice Address - Phone:706-866-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10231207314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0109151OtherBCBS TN
GA00344759AMedicaid
702015332OtherCARITEN
702015332OtherCARITEN