NPIMap

Organization Active NPI

Eastside Medical Center, LLC

Doing business as Eastside Medical Center

  • General Acute Care Hospital
  • Snellville, GA
National Provider Identifier
1649224692
Registry record updated Jan 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
EASTSIDE MEDICAL CENTER, LLC
Doing business as
Eastside Medical Center
Practice address
1700 Medical Way
Snellville, GA 30078-2195
Phone
(770) 979-0200
Fax
(770) 736-2395
NPI assigned
May 22, 2006
Last updated
Jan 24, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2017

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

Authorized official

Name
Amy N. Wheeler
Title
Cfo
Phone
(770) 736-2420

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU Primary

Addresses

Primary practice location

1700 Medical Way
Snellville, GA 30078-2195

Mailing address

1700 Medical Way
Snellville, GA 30078-2195
Phone (770) 979-0200

Other identifiers 1

IdentifierTypeStateIssuer
404383429MedicaidMI

Other names 1

  • EASTSIDE MEDICAL CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Eastside Medical Center LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485216000000",
    "number": "1649224692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 MEDICAL WAY",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782195",
            "telephone_number": "770-979-0200",
            "fax_number": "770-736-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 MEDICAL WAY",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782195",
            "telephone_number": "770-979-0200",
            "fax_number": "770-736-2395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2017-01-24",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "770-736-2420"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404383429",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EASTSIDE MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Snellville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; 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.