NPIMap

Organization Active NPI

TMC Villa Rica Hospital, Inc

Doing business as NW Ga Oncology Ctr Retail Pharmacy - TMC/Villa Rica

  • Community/Retail Pharmacy
  • Carrollton, GA
National Provider Identifier
1679195606
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
TMC VILLA RICA HOSPITAL, INC
Doing business as
NW Ga Oncology Ctr Retail Pharmacy - TMC/Villa Rica
Practice address
157 Clinic Ave Ste 202, Room 219
Carrollton, GA 30117-4454
Phone
(770) 812-1919
NPI assigned
May 13, 2020
Last updated
Sep 8, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
TMC VILLA RICA HOSPITAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Authorized official

Name
Carol S. Crews, CFO
Title
Cfo
Phone
(770) 812-9745

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary
Specialty Pharmacy 3336S0011X NU

Addresses

Primary practice location

157 Clinic Ave Ste 202, Room 219
Carrollton, GA 30117-4454

Mailing address

100 Professional PL Ste 305
Carrollton, GA 30117-3872
Phone (770) 812-8614

Other identifiers 1

IdentifierTypeStateIssuer
5KYKWKNF2OtherHEALTH INDUSTRY NUMBER

Other names 1

  • NW Ga Oncology Ctr Retail Pharmacy - TMC/Villa Rica Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200826001703 GA Part B Supplier - Pharmacy 2961307533 Practice locations: Carrollton, GA

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
TMC Villa Rica Hospital Inc3 organizations share this tax ID, including this one
Part of
TMC Villa Rica Hospital Inc

Other organizations with this tax ID 2

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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": "1589328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1679195606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL PL STE 305",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173872",
            "telephone_number": "770-812-8614",
            "fax_number": "770-812-8372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 CLINIC AVE STE 202, ROOM 219",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174454",
            "telephone_number": "770-812-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TMC VILLA RICA HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TMC VILLA RICA HOSPITAL, INC",
        "enumeration_date": "2020-05-13",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "CREWS",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "770-812-9745",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH INDUSTRY NUMBER",
            "identifier": "5KYKWKNF2",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NW Ga Oncology Ctr Retail Pharmacy - TMC/Villa Rica",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NW Ga Oncology Ctr Retail Pharmacy - TMC/Villa Rica",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carrollton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.