Active NPI
Clinch County Hospital Authority
- Community/Retail Pharmacy
- Homerville, GA
National Provider Identifier
1518550870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- CLINCH COUNTY HOSPITAL AUTHORITY
- Practice address
- 1050 Valdosta Hwy
Homerville, GA 31634-9701 - Phone
- (912) 487-4350
- NPI assigned
- Feb 18, 2021
- Last updated
- Feb 18, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Angela P Ammons
- Title
- Ceo
- Phone
- (912) 487-4348
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
1050 Valdosta Hwy
Homerville, GA 31634-9701
Mailing address
1050 Valdosta Hwy
Homerville, GA 31634-9701
Phone (912) 487-4350
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220202001676 | GA | Part B Supplier - Pharmacy | 7416849922 | Practice locations: Homerville, GA |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Medicare Defined Swing Bed Hospital Unit
- Homerville, GA
- NPI 1891738308
7416849922
National Provider Directory
National Provider Directory- Tax ID family
- Clinch County Hospital Authority
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Clinch Memorial Family Practice
- Primary Care Clinic/Center
- Homerville, GA
- NPI 1154895969
Ownership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Clinch Memorial Hospital | Hospital | Operational/Managerial Control | Apr 6, 2007 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Critical Access Hospital
- Homerville, GA
- NPI 1861478851
Operational/Managerial Control
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613606400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1613606400000",
"number": "1518550870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1050 VALDOSTA HWY",
"city": "HOMERVILLE",
"state": "GA",
"postal_code": "316349701",
"telephone_number": "912-487-4350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 VALDOSTA HWY",
"city": "HOMERVILLE",
"state": "GA",
"postal_code": "316349701",
"telephone_number": "912-487-4350"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CLINCH COUNTY HOSPITAL AUTHORITY",
"organizational_subpart": "NO",
"enumeration_date": "2021-02-18",
"last_updated": "2021-02-18",
"certification_date": "2021-02-18",
"status": "A",
"authorized_official_last_name": "AMMONS",
"authorized_official_first_name": "ANGELA",
"authorized_official_middle_name": "P",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "912-487-4348"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Homerville, GA
- CL SNF LLC (River Brook Healthcare Center)
- Betsy Daugharty Clifton, FNP-C
- Clinch County Board of Education
- Clinch County Board of Health
- Clinch County Hospital Authority (Clinch Memorial Family Practice)
- Clinch County Hospital Authority
- Clinch County Hospital Authority
- Clinch CS
- Clinch Healthcare LLC (Clinch HealthCare)
- Clinch Healthcare, LLC (Clinch Healthcare Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.