NPIMap

Organization Active NPI

Colquitt Regional Medical Center

  • Land Ambulance
  • Moultrie, GA
National Provider Identifier
1720593239
Registry record updated Dec 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
Legal business name
COLQUITT REGIONAL MEDICAL CENTER
Practice address
3131 S Main St
Moultrie, GA 31768-6925
Phone
(229) 891-9277
Fax
(229) 502-9645
NPI assigned
Dec 6, 2017
Organization subpart
Yes
Parent organization
COLQUITT REGIONAL MEDICAL CENTERAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Greg Johnson
Title
Coo
Phone
(229) 985-3420

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 8

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

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

Practitioners 20

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

View all 20

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2199858Colquitt County EMS3131 South Main Street, Moultrie, GA 31768Certificate of waiverNov 11, 2026

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180615001542 GA Part B Supplier - Ambulance Service Supplier 6204821796 Practice locations: Moultrie, GA

All facility ownership & control disclosures 2

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Colquitt Regional Home Care ServicesMoultrie, GA, CCN 117044 Home health agency Operational/Managerial Control Feb 1, 1987
Colquitt Regional HospiceMoultrie, GA, CCN 111542 Hospice 5% Or Greater Direct Ownership Interest (100%) Oct 13, 2015

National Provider Directory

National Provider Directory
Tax ID family
Robert Hawes MD14 organizations share this tax ID, including this one
Part of
Robert Hawes MD

Other organizations with this tax ID 13

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

View all 13

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X Primary

Addresses

NPPES NPI Registry

Primary practice location

3131 S Main St
Moultrie, GA 31768-6925

Mailing address

PO Box 2172
Moultrie, GA 31776-2172
Phone (229) 891-9277

Other names 1

NPPES NPI Registry
  • Colquitt County EMS 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 Dec 6, 2017.

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512518400000",
    "number": "1720593239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2172",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317762172",
            "telephone_number": "229-891-9277",
            "fax_number": "229-502-9645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686925",
            "telephone_number": "229-891-9277",
            "fax_number": "229-502-9645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLQUITT REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLQUITT REGIONAL MEDICAL CENTER",
        "enumeration_date": "2017-12-06",
        "last_updated": "2017-12-06",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "229-985-3420"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colquitt County EMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moultrie, GA

Sources for this page

Verify at the official NPI Registry.