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Organization Active NPI

Phoebe Putney Memorial Hospital, Inc.

  • Psychiatric Hospital Unit
  • Albany, GA
National Provider Identifier
1669438404
Registry record updated Jul 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
PHOEBE PUTNEY MEMORIAL HOSPITAL, INC.
Practice address
417 W 3Rd Ave
Albany, GA 31701
Phone
(229) 312-4268
Fax
(229) 312-4316
NPI assigned
Apr 21, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mrs. Nicole Brueder
Title
Avp, Business Affairs
Phone
(229) 312-4268

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs with the same Medicare PAC ID 7

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

Corporate family (same tax ID) 29

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

View all 29

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 76

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

View all 76

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Hospital certification: CCN 11S007

Medicare enrollment files
Legal name
PHOEBE PUTNEY MEMORIAL HOSPITAL, INC.
Doing business as
PHOEBE PUTNEY MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Dec 10, 1990 in GA
Enrollment address
417 West Third Avenue
Albany, GA 31701-1943
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

All disclosed owners & managing parties 14

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Chinyelu Ofodile Individual Corporate OfficerVolunteer Board Member Jan 9, 2025
Karen Thornton Individual Corporate OfficerVolunteer Board Member Nov 4, 2014
Marvin Laster Individual Corporate OfficerVolunteer Board Member Mar 1, 2019
Jenny Yin Savelle Individual Corporate OfficerVolunteer Board Member Mar 1, 2022
James E Black Individual Corporate OfficerVolunteer Board Member Jan 9, 2025
Phoebe Putney Health Systems Inc Organization, Albany, GA Non-profit 5% Or Greater Direct Ownership Interest Feb 12, 2008 100%
William J McAfee Individual Corporate OfficerVolunteer Board Member Mar 1, 2019
Pamela Green Jackson Individual Corporate OfficerVolunteer Board Member Mar 1, 2022
Scott Steiner Individual Corporate DirectorCeo Mar 1, 2019
Derek J Heard Individual Corporate OfficerVolunteer Board Member Mar 1, 2022
William Griffin Individual Corporate OfficerVolunteer Board Member Jan 9, 2025
Brian a Church Individual Corporate OfficerCfo & Admin Officer Aug 1, 2015
W-2 Managing Employee Jan 1, 2023
James Webb Individual Corporate OfficerVolunteer Board Member Mar 1, 2019
Tiera a Barron Individual Corporate OfficerVolunteer Board Member Jan 9, 2025

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20080220000698 GA Part a Provider - Hospital 4486559549 Practice locations: Albany, GA

National Provider Directory

National Provider Directory
Tax ID family
Phoebe Putney Memorial (30 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

417 W 3Rd Ave
Albany, GA 31701

Mailing address

PO Box 3770
Albany, GA 31706-3770
Phone (229) 312-4268

Other names 1

NPPES NPI Registry
  • Phoebe Putney Memorial Hosptial Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 2, 2013.

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372723200000",
    "number": "1669438404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3770",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317063770",
            "telephone_number": "229-312-4268",
            "fax_number": "229-312-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 W 3RD AVE",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "31701",
            "telephone_number": "229-312-4268",
            "fax_number": "229-312-4316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOEBE PUTNEY MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2013-07-02",
        "status": "A",
        "authorized_official_last_name": "BRUEDER",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "AVP, BUSINESS AFFAIRS",
        "authorized_official_telephone_number": "229-312-4268",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoebe Putney Memorial Hosptial",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albany, GA

Sources for this page

Verify at the official NPI Registry.