NPIMap

Organization Active NPI

Colquitt Regional Medical Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Moultrie, GA
National Provider Identifier
1124155965
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
035296 Issued in GA
Legal business name
COLQUITT REGIONAL MEDICAL CENTER
Practice address
15 Hospital Park
Moultrie, GA 31768-6772
Phone
(229) 891-9333
NPI assigned
Feb 28, 2007
Organization subpart
Yes
Parent organization
COLQUITT REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 30, 2025

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

Authorized official

Name
Mr. Jim Matney
Title
President/Ceo
Phone
(229) 985-3420

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 035296 GA Primary

Addresses

Primary practice location

15 Hospital Park
Moultrie, GA 31768-6772

Mailing address

3131 S Main St
Moultrie, GA 31768-6925
Phone (229) 985-3420

Other identifiers 1

IdentifierTypeStateIssuer
000408845AMedicaidGA

Other names 1

  • Colquitt Regional Medical Center Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091022000562 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 6204821796 Practice locations: Moultrie, GA

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Robert Hawes MD14 organizations share this tax ID, including this one
Part of
Robert Hawes MD

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Colquitt Regional Home Care ServicesMoultrie, GA, CCN 117044 Home health agency Operational/Managerial Control Feb 1, 1987
Colquitt Regional HospiceMoultrie, GA, CCN 111542 Hospice 5% Or Greater Direct Ownership Interest (100%) Oct 13, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748563200000",
    "number": "1124155965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686925",
            "telephone_number": "229-985-3420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 HOSPITAL PARK",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686772",
            "telephone_number": "229-891-9333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLQUITT REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLQUITT REGIONAL MEDICAL CENTER",
        "enumeration_date": "2007-02-28",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A",
        "authorized_official_last_name": "MATNEY",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "229-985-3420",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "035296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000408845A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colquitt Regional Medical Center Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moultrie, GA

Sources for this page

Verify at the official NPI Registry.