NPIMap

Organization Active NPI

Emanuel County Hospital Authority

Doing business as Emanuel Prompt Care

  • Rural Health Clinic/Center
  • Swainsboro, GA
National Provider Identifier
1063649903
Registry record updated Jan 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EMANUEL COUNTY HOSPITAL AUTHORITY
Doing business as
Emanuel Prompt Care
Practice address
131 Victory Dr
Swainsboro, GA 30401-3234
Phone
(478) 289-1376
NPI assigned
Jun 18, 2009
Last updated
Jan 31, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Steven F King
Title
Cfo
Phone
(478) 289-1376

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

131 Victory Dr
Swainsboro, GA 30401-3234

Mailing address

117 Kite Rd
Swainsboro, GA 30401-3231

Other names 1

  • Emanuel Prompt Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091221000668 GA Part A Provider - Rural Health Clinic 3577473040 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Swainsboro, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063649903. Details of each certification follow.

Rural health clinic certification: CCN 118526

Legal name
EMANUEL COUNTY HOSPITAL AUTHORITY
Doing business as
RAY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 4, 2010
Last certification
Mar 21, 2022
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
401 W Main St
Swainsboro, GA 30401-3110
Related CCNs
110109

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

117 Kite Rd
Fl 2
Swainsboro, GA 30401
Phone (478) 289-1150

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joe L English Individual Corporate Director Aug 1, 2009
Emanuel County Hospital Authority Organization, Swainsboro, GA 5% Or Greater Direct Ownership Interest Jan 1, 2009 100%
Steven E King Individual Corporate OfficerCfo Apr 1, 2013
George Kirk Olsen Individual Corporate DirectorAdministrator Apr 1, 2013
Vijitha P Prasad Individual Corporate Director Jan 1, 2013
Jessica Johnson Individual W-2 Managing Employee May 18, 1987
Paige P Wynn Individual W-2 Managing EmployeeChief Financial Officer Oct 1, 2014

Owners & managing parties with NPI records 11

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391126400000",
    "number": "1063649903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 KITE RD",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304013231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 VICTORY DR",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304013234",
            "telephone_number": "478-289-1376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMANUEL COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-18",
        "last_updated": "2014-01-31",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "478-289-1376"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emanuel Prompt Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Swainsboro, GA

Sources for this page

Verify at the official NPI Registry.