NPIMap

Organization Active NPI

Flint River Medi Cal Group, LLC

  • Surgery Physician
  • Montezuma, GA
National Provider Identifier
1235340969
Registry record updated Aug 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
FLINT RIVER MEDI CAL GROUP, LLC
Practice address
509 Sumter St
Montezuma, GA 31063-1733
Phone
(478) 472-3100
Fax
(478) 472-2412
NPI assigned
May 24, 2007
Last updated
Aug 27, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2013

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

Authorized official

Name
Mr. Philp H Eastman III, CEO
Title
Chief Executive Office
Phone
(770) 904-6731

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

509 Sumter St
Montezuma, GA 31063-1733

Mailing address

509 Sumter St
Montezuma, GA 31063-1733
Phone (478) 472-3100

National Provider Directory

National Provider Directory

Locations

509 Sumter St
Ste D
Montezuma, GA 31063
Phone (478) 472-3134

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377561600000",
    "number": "1235340969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 SUMTER ST",
            "city": "MONTEZUMA",
            "state": "GA",
            "postal_code": "310631733",
            "telephone_number": "478-472-3100",
            "fax_number": "478-472-2412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 SUMTER ST",
            "city": "MONTEZUMA",
            "state": "GA",
            "postal_code": "310631733",
            "telephone_number": "478-472-3100",
            "fax_number": "478-472-2412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLINT RIVER MEDI CAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2013-08-27",
        "status": "A",
        "authorized_official_last_name": "EASTMAN",
        "authorized_official_first_name": "PHILP",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICE",
        "authorized_official_telephone_number": "770-904-6731",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montezuma, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.