Jesup Healthcare LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1-151-1864 Issued in GA

Legal business name

JESUP HEALTHCARE LLC

Doing business as

Jesup HealthCare

Practice address

3100 Savannah Hwy
Jesup, GA 31545-5514

Phone

(912) 427-6873

Fax

(912) 530-6713

NPI assigned

Jun 10, 2006

Organization subpart

No

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

Authorized official

Name

Tygh Angwin Brogdon

Title

Manager

Phone

(770) 650-8773

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jesup HealthCare Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Jesup Health and Rehab2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Jesup Operator LLC

  dba Jesup Health and Rehab

  • Skilled Nursing Facility
  • Jesup, GA
  • NPI 1952573040
  NPD tax ID

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222646400000",
    "number": "1679514434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SAVANNAH HWY",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315455514",
            "telephone_number": "912-427-6873",
            "fax_number": "912-530-6713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SAVANNAH HWY",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315455514",
            "telephone_number": "912-427-6873",
            "fax_number": "912-530-6713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESUP HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2008-09-29",
        "status": "A",
        "authorized_official_last_name": "BROGDON",
        "authorized_official_first_name": "TYGH",
        "authorized_official_middle_name": "ANGWIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-650-8773"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "1-151-1864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000142689A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jesup HealthCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeffrey L. Harris, MD, PC (Wayne Obstetrics and Gynecology)
• Oliver H Jenkins, MD
• Victoria I Jeske, DPT, PT
• Jesup Emergency Services, LLC
• Jesup Health Care and Family Practice (Jesup Urgent Care)
• Jesup Operator LLC (Jesup Health and Rehab)
• Jesup Pediatrics, P.C.
• Jesup Ridge of Journey LLC
• Jesupcare Anesthesia, PC
• John Lex Kenerly, III, MD

• Skilled Nursing Facility in Jesup, GA
• Providers in Jesup, GA by specialty
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.