NPIMap

Organization Active NPI

South Central Primary Care Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Fitzgerald, GA
National Provider Identifier
1295094340
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTH CENTRAL PRIMARY CARE CENTER, INC
Practice address
299 W Benjamin Hill Dr
Suite a
Fitzgerald, GA 31750
Phone
(229) 423-5437
NPI assigned
May 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Authorized official

Name
Robert Bonds Tucker
Title
Ceo
Phone
(229) 468-9166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

299 W Benjamin Hill Dr
Suite a
Fitzgerald, GA 31750

Mailing address

204 E 4TH St
P O Box 749
Ocilla, GA 31774-1421
Phone (229) 468-9166

Other identifiers 1

IdentifierTypeStateIssuer
0003124446AMedicaidGA

Other names 1

  • KIDS HEALTH FITZGERALD Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2232367Kids Health of Fitzgerald299 Benjamin Hill Drive, Suite a, Fitzgerald, GA 31750Certificate of waiverAug 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
South CTRL Primary Care13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1336608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1295094340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 E 4TH ST",
            "address_2": "P O BOX 749",
            "city": "OCILLA",
            "state": "GA",
            "postal_code": "317741421",
            "telephone_number": "229-468-9166",
            "fax_number": "229-468-9188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 W BENJAMIN HILL DR",
            "address_2": "SUITE A",
            "city": "FITZGERALD",
            "state": "GA",
            "postal_code": "31750",
            "telephone_number": "229-423-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL PRIMARY CARE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-10",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "BONDS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-468-9166"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0003124446A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KIDS HEALTH FITZGERALD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fitzgerald, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.