NPIMap

Organization Active NPI

McKinney Community Health Ctr, Inc

  • Federally Qualified Health Center (FQHC)
  • Blackshear, GA
National Provider Identifier
1568623346
Registry record updated Oct 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MCKINNEY COMMUNITY HEALTH CTR, INC
Practice address
623 Sycamore St
Blackshear, GA 31516-2119
Phone
(912) 449-3294
Fax
(912) 287-1568
NPI assigned
Jun 24, 2008
Last updated
Oct 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2008

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

Authorized official

Name
Ms. Ola Smith
Title
Ceo
Phone
(912) 287-0301

Specialties & licenses 1

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

Addresses

Primary practice location

623 Sycamore St
Blackshear, GA 31516-2119

Mailing address

218 Quarterman St
Waycross, GA 31501-3547
Phone (912) 287-0301

Other identifiers 3

IdentifierTypeStateIssuer
000715415CMedicaidGA
10066125OtherGAAMERIGROUP
336245OtherGAWELLCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568623346. Details of each certification follow.

  • CCN 111874 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 111874

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MCKINNEY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 25, 2003
Last certification
Nov 25, 2003
Ownership / control type
For profit – corporation
Facility address
623 Sycamore Street
Blackshear, GA 31516

National Provider Directory

National Provider Directory

Locations

623 Sycamore St
Blackshear, GA 31516
Phone (912) 449-3294

Practitioners & affiliated clinicians

Practitioners 37

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.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225238400000",
    "number": "1568623346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 QUARTERMAN ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315013547",
            "telephone_number": "912-287-0301",
            "fax_number": "912-287-1568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 SYCAMORE ST",
            "city": "BLACKSHEAR",
            "state": "GA",
            "postal_code": "315162119",
            "telephone_number": "912-449-3294",
            "fax_number": "912-287-1568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKINNEY COMMUNITY HEALTH CTR, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-24",
        "last_updated": "2008-10-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "OLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-287-0301",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000715415C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10066125",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "336245",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blackshear, GA

Sources for this page

Verify at the official NPI Registry.