Georgia CVS Pharmacy, L.L.C.
Organization Active NPI Pharmacy · Bainbridge, GA
NPI 1164525994 · NPPES record last updated Jan 17, 2023
Key facts
- NPI
- 1164525994
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 006729 (GA)
- Legal business name
- GEORGIA CVS PHARMACY, L.L.C.
- Practice address
- 817 E Shotwell St
Bainbridge, GA 39819-4145 - Phone
- (912) 243-0374
- NPI assigned
- Sep 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Director, Payer Relations
- Phone
- (401) 770-2751
Corporate family (same tax ID) 24
Member of 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Georgia CVS Pharmacy, L.L.C. |
Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100209000543 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8123161429 | This NPI is an additional NPI on the enrollment |
| O20100930071583 | GA | DME Supplier - Pharmacy | 8123161429 | Practice locations: Bainbridge, GA |
National Provider Directory
- Tax ID family
- CVS Pharmacy 06861
Locations
817 E Shotwell St
Bainbridge, GA 39819
Phone (229) 243-0373
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 006729 | GA | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
817 E Shotwell St
Bainbridge, GA 39819-4145
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004312200 | Medicaid | FL | |
| 000336234B | Medicaid | GA | |
| 1131010 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names
- CVS PHARMACY #04535
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | ABILITY Network |
Other providers in Bainbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2023. 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.