NPIMap

Organization Active NPI

John D. Archbold Memorial Hospital, Inc.

Doing business as Archbold Pinetree Pharmacy

  • Community/Retail Pharmacy
  • Thomasville, GA
National Provider Identifier
1467430819
Registry record updated May 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.
Doing business as
Archbold Pinetree Pharmacy
Practice address
2705 E Pinetree Blvd
Thomasville, GA 31792-4875
Phone
(229) 551-2365
Fax
(229) 551-2397
NPI assigned
Jan 5, 2006
Last updated
May 21, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 21, 2024

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

Authorized official

Name
Tara King
Title
Avp
Phone
(229) 228-2229

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary
Home Infusion Therapy Pharmacy 3336H0001X
Long Term Care Pharmacy 3336L0003X PHRE007122 GA

Addresses

Primary practice location

2705 E Pinetree Blvd
Thomasville, GA 31792-4875

Mailing address

2705 E Pinetree Blvd Ste F
Thomasville, GA 31792-4875
Phone (229) 551-2377

Other identifiers 2

IdentifierTypeStateIssuer
00420318AMedicaidGA
2020500OtherPK

Other names 2

  • Archbold Pinetree Pharmacy Doing business as
  • Archbold Health Services, Inc. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200212001281 GA Part B Supplier - Pharmacy 4789721416 Practice locations: Thomasville, GA
O20250107003833 GA DME Supplier - PharmacyDME Supplier - Medical Supply Company 4981502622 Practice locations: Thomasville, GA

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
John D Archbold Mem Hosp16 organizations share this tax ID, including this one
Part of
John D Archbold Mem Hosp

Other organizations with this tax ID 15

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

View all 15

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1057 5th St SE
Cairo, GA 39828
Phone (229) 297-6200

240 5th St NE
Cairo, GA 39828
Phone (229) 377-8347

910 N Court St
Quitman, GA 31643
Phone (229) 263-4444

400 Old Albany Rd
Thomasville, GA 31792
Phone (229) 228-2200

818 Gordon Ave
Thomasville, GA 31792
Phone (229) 227-5520

Ownership & related parties

All facility ownership & control disclosures 14

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Archbold Brooks SwingbedQuitman, GA, CCN 11Z332 Hospital Operational/Managerial Control Jun 1, 1987
Archbold GradyCairo, GA, CCN 110121 Hospital Operational/Managerial Control Apr 26, 2007
Archbold Grady SwingbedCairo, GA, CCN 11U121 Hospital Operational/Managerial Control Apr 26, 2007
Archbold MitchellCamilla, GA, CCN 111331 Hospital Operational/Managerial Control Jul 2, 1990
Archbold Mitchell SwingbedCamilla, GA, CCN 11Z331 Hospital Operational/Managerial Control Dec 20, 2006
Archbold BrooksQuitman, GA, CCN 111332 Hospital Operational/Managerial Control Jun 11, 1987
Mitchell County Nursing HomesCamilla, GA, CCN 115266 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 1990
Oct 1, 1990
Archbold Living ThomasvilleThomasville, GA, CCN 115480 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 1994
Apr 11, 2025
Archbold Living CairoCairo, GA, CCN 115776 Skilled nursing facility Adp of the SNF
Indirect Ownership Interest (100%)		 Jun 19, 2025
Sep 26, 2023
Archbold Home Health ServicesThomasville, GA, CCN 117024 Home health agency 5% Or Greater Indirect Ownership Interest (25%) May 1, 2022
Hospice of Southwest GeorgiaThomasville, GA, CCN 111521 Hospice 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2023
Jan 1, 2023
Archbold Pediatrics CamillaCamilla, GA, CCN 113474 Rural health clinic Operational/Managerial Control (100%) May 29, 2014
Archbold Primary Care CamillaCamilla, GA, CCN 118519 Rural health clinic Operational/Managerial Control (100%) Jul 2, 1990
Archbold Primary Care PelhamPelham, GA, CCN 118544 Rural health clinic Operational/Managerial Control (100%) Aug 26, 2013

Owned or controlled facilities with NPI records 17

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 17

Practitioners & affiliated clinicians

Practitioners 3

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": "1136419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716249600000",
    "number": "1467430819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 E PINETREE BLVD STE F",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317924875",
            "telephone_number": "229-551-2377",
            "fax_number": "229-551-2397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 E PINETREE BLVD",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317924875",
            "telephone_number": "229-551-2365",
            "fax_number": "229-551-2397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.",
        "enumeration_date": "2006-01-05",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "AVP",
        "authorized_official_telephone_number": "229-228-2229"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "GA",
            "license": "PHRE007122",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00420318A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2020500",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Archbold Pinetree Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Archbold Pinetree Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Archbold Health Services, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Thomasville, GA

Sources for this page

Verify at the official NPI Registry.