NPIMap

Organization Active NPI

Coffee Regional Medical Center

  • Pharmacy
  • Douglas, GA
National Provider Identifier
1679784680
Registry record updated Dec 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
COFFEE REGIONAL MEDICAL CENTER
Practice address
1101 Ocilla Rd
Douglas, GA 31533-2207
Phone
(912) 384-1900
NPI assigned
May 24, 2007
Last updated
Dec 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2008

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

Authorized official

Name
Donald C Lewis
Title
VP of Finance
Phone
(912) 384-1900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary

Addresses

Primary practice location

1101 Ocilla Rd
Douglas, GA 31533-2207

Mailing address

PO Box 1287
Douglas, GA 31534-1287
Phone (912) 384-1900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040402000287 GA Part B Supplier - Clinic/Group Practice 4587656012 Receives reassigned benefits from 75 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Douglas, GA

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Coffee Regional6 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.

Practitioners & affiliated clinicians

Practitioners 6

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": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228089600000",
    "number": "1679784680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1287",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315341287",
            "telephone_number": "912-384-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 OCILLA RD",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332207",
            "telephone_number": "912-384-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEE REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2008-12-01",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "912-384-1900"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglas, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2008; 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.