NPIMap

Organization Active NPI

Memorial Health Partners Foundation, Inc.

Doing business as Professional Park Associates

  • Non-Pharmacy Dispensing Site
  • La Fayette, GA
National Provider Identifier
1669861530
Registry record updated Jan 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
MEMORIAL HEALTH PARTNERS FOUNDATION, INC.
Doing business as
Professional Park Associates
Practice address
611 E Villanow St
La Fayette, GA 30728-2618
Phone
(706) 638-1606
Fax
(706) 638-9987
NPI assigned
Jan 15, 2015
Last updated
Jan 15, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL HEALTH PARTNERS FOUNDATION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2015

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

Authorized official

Name
Ramon Figueroa
Title
Director Physician Operations
Phone
(423) 424-1551

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

611 E Villanow St
La Fayette, GA 30728-2618

Mailing address

611 E Villanow St
La Fayette, GA 30728-2618
Phone (706) 638-1606

Other names 1

  • Professional Park Associates Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Memorial Health Partners Foundation Inc2 organizations share this tax ID, including this one
Part of
Memorial Health Partners Foundation Inc

Other organizations with this tax ID 1

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

Locations

611 E Villanow St
La Fayette, GA 30728
Phone (706) 638-1606

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1421280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421280000000",
    "number": "1669861530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 E VILLANOW ST",
            "city": "LA FAYETTE",
            "state": "GA",
            "postal_code": "307282618",
            "telephone_number": "706-638-1606",
            "fax_number": "706-638-9987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E VILLANOW ST",
            "city": "LA FAYETTE",
            "state": "GA",
            "postal_code": "307282618",
            "telephone_number": "706-638-1606",
            "fax_number": "706-638-9987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HEALTH PARTNERS FOUNDATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL HEALTH PARTNERS FOUNDATION, INC.",
        "enumeration_date": "2015-01-15",
        "last_updated": "2015-01-15",
        "status": "A",
        "authorized_official_last_name": "FIGUEROA",
        "authorized_official_first_name": "RAMON",
        "authorized_official_title_or_position": "DIRECTOR PHYSICIAN OPERATIONS",
        "authorized_official_telephone_number": "423-424-1551"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Park Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Fayette, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2015; 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.