NPIMap

Organization Active NPI

McIntosh Trail Community Service Board

  • Community/Behavioral Health Agency
  • Jackson, GA
National Provider Identifier
1265610406
Registry record updated Dec 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MCINTOSH TRAIL COMMUNITY SERVICE BOARD
Practice address
463 Ernest Biles Dr
Suite B
Jackson, GA 30233-2229
Phone
(770) 775-2676
NPI assigned
Feb 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2015

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

Authorized official

Name
Shari Thomas
Title
Cfo
Phone
(770) 358-8254

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

463 Ernest Biles Dr
Suite B
Jackson, GA 30233-2229

Mailing address

1435 N Expressway
Suite 301
Griffin, GA 30223-9016
Phone (770) 358-8250

Other identifiers 1

IdentifierTypeStateIssuer
000601609AMedicaidGA

Other names 1

  • McIntosh Tr MH MR SA CSB Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040601001239 GA Part B Supplier - Clinic/Group Practice 6204818669 Receives reassigned benefits from 49 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fayetteville, GA; Griffin, GA; Jackson, GA; McDonough, GA; Thomaston, GA

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
McIntosh Trail CSB29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Locations

463 Ernest Biles Dr
#B
Jackson, GA 30233
Phone (770) 775-2676

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1202428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450310400000",
    "number": "1265610406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1435 N EXPRESSWAY",
            "address_2": "SUITE 301",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302239016",
            "telephone_number": "770-358-8250",
            "fax_number": "770-229-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "463 ERNEST BILES DR",
            "address_2": "SUITE B",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302332229",
            "telephone_number": "770-775-2676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCINTOSH TRAIL COMMUNITY SERVICE BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-08",
        "last_updated": "2015-12-17",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "SHARI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "770-358-8254"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000601609A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McIntosh Tr MH MR SA CSB",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jackson, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.