NPIMap

Organization Active NPI

Rural Health Center of Southeast Ga.,Inc.

  • Rural Health Clinic/Center
  • Vidalia, GA
National Provider Identifier
1508910241
Registry record updated Jan 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
RURAL HEALTH CENTER OF SOUTHEAST GA.,INC.
Practice address
300 Arlington Dr.
Vidalia, GA 30474
Phone
(912) 538-0830
Fax
(912) 538-1333
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2008

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

Authorized official

Name
Mr. John Burton DerrickNPI 1932253606
Title
Ceo
Phone
(912) 538-0830

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

300 Arlington Dr.
Vidalia, GA 30474

Mailing address

300 Arlington Dr.
PO Box 645
Vidalia, GA 30475-0645
Phone (912) 538-0830

Other identifiers 1

IdentifierTypeStateIssuer
00741243AMedicaidGA

Other names 1

  • family health center Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201478400000",
    "number": "1508910241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 ARLINGTON DR.",
            "address_2": "PO BOX 645",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304750645",
            "telephone_number": "912-538-0830",
            "fax_number": "912-538-1333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 ARLINGTON DR.",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "30474",
            "telephone_number": "912-538-0830",
            "fax_number": "912-538-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH CENTER OF SOUTHEAST GA.,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2008-01-28",
        "status": "A",
        "authorized_official_last_name": "DERRICK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BURTON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-538-0830",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00741243A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "family health center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vidalia, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; 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.