NPIMap

Organization Active NPI

Glynn County Board of Health

  • Public Health or Welfare Agency
  • Brunswick, GA
National Provider Identifier
1164429692
Registry record updated Jan 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
GLYNN COUNTY BOARD OF HEALTH
Practice address
2747 4TH St
Brunswick, GA 31520-3714
Phone
(912) 264-3236
Fax
(912) 262-3051
NPI assigned
Jun 30, 2005
Organization subpart
Yes
Parent organization
GLYNN COUNTY BOARD OF HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 6, 2015

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

Authorized official

Name
Stacy A. Cooper
Title
District Billing Dept. Coordinator
Phone
(912) 262-2347

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X Primary

Addresses

Primary practice location

2747 4TH St
Brunswick, GA 31520-3714

Mailing address

150 Scranton Connector
Brunswick, GA 31525-0540
Phone (912) 262-2347

Other identifiers 2

IdentifierTypeStateIssuer
FLU143OtherGAMEDICARE NUMBER
000456508PMedicaidGA

Other names 1

  • Coastal Health District-Brunswick Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040309001226 GA Part B Supplier - Clinic/Group Practice 4385532456 Receives reassigned benefits from 15 practitioners
Practice locations: Brunswick, GA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Glynn County Health Dep5 organizations share this tax ID, including this one
Part of
Glynn County Health Dep

Other organizations with this tax ID 4

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

Locations

107 Fahm St
#B
Savannah, GA 31401
Phone (912) 651-2253

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420502400000",
    "number": "1164429692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 SCRANTON CONNECTOR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315250540",
            "telephone_number": "912-262-2347",
            "fax_number": "912-262-3036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2747 4TH ST",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315203714",
            "telephone_number": "912-264-3236",
            "fax_number": "912-262-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLYNN COUNTY BOARD OF HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GLYNN COUNTY BOARD OF HEALTH",
        "enumeration_date": "2005-06-30",
        "last_updated": "2015-01-06",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "DISTRICT BILLING DEPT. COORDINATOR",
        "authorized_official_telephone_number": "912-262-2347"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NUMBER",
            "identifier": "FLU143",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000456508P",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Health District-Brunswick",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brunswick, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.