Mid Georgia Total Care LLC
Organization Active NPI Family Medicine Physician · Eastman, GA
NPI 1003200015 · NPPES record last updated Mar 30, 2015
Key facts
- NPI
- 1003200015
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MID GEORGIA TOTAL CARE LLC
- Practice address
- 1111 Griffin Ave
Ste 1B
Eastman, GA 31023-9104 - Phone
- (478) 374-8998
- Fax
- (478) 374-8525
- NPI assigned
- Mar 27, 2015
- Organization subpart
- No
Authorized official
- Name
- Kevin Bierschenk
- Title
- Ceo
- Phone
- (478) 344-2550
Member of 1
Practitioners 3
-
Blake E Milner, M.D.
-
Bart Steele Milner, P.A.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2099846 | Mid-Georgia Total Care | Certificate of waiver | Aug 3, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150729008143 | GA | Part B Supplier - Clinic/Group Practice | 4587978960 |
Receives reassigned benefits from 3 practitioners Practice locations: Eastman, GA |
National Provider Directory
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/CEBDAD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | GA | Yes |
Addresses
Primary practice location
1111 Griffin Ave
Ste 1B
Eastman, GA 31023-9104
Mailing address
1111 Griffin Ave
Ste 1B
Eastman, GA 31023-9104
Phone (478) 374-8998
Other providers in Eastman, GA
- Thomas Milton Meadows
- Katrina Dion Means
- Med Cross Imaging LLC
- Medical Center Prescription Shop
- Medical Center Prescription Shop
- Middle Ga Family Practice LLC
- Middle Georgia Family Medicine,LLC
- Middle Georgia Nursing Home, Inc
- Middle Georgia Nursing Home, Inc.
- Middle Georgia Sleep & Wellness Center, LLC
All providers in Eastman, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.