NPIMap

Organization Active NPI

Provident Health Services, Inc.

  • Hospitalist Physician
  • Savannah, GA
National Provider Identifier
1740341783
Registry record updated Jun 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
PROVIDENT HEALTH SERVICES, INC.
Doing business as
Memorial Health Hospitalists
Practice address
4700 Waters Ave
Memorial Health Hospitalists
Savannah, GA 31404-6220
Phone
(912) 350-2155
Fax
(912) 350-2156
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2009

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

Authorized official

Name
Mrs. Robin J. Maddox
Title
Provider Enrollment Coordinator
Phone
(912) 350-9335

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X Primary

Addresses

Primary practice location

4700 Waters Ave
Memorial Health Hospitalists
Savannah, GA 31404-6220

Mailing address

4700 Waters Ave
Memorial Health Hospitalists
Savannah, GA 31404-6220
Phone (912) 350-2155

Other identifiers 4

IdentifierTypeStateIssuer
DF7661OtherSCRR MEDICARE
609293670AMedicaidGA
DA3772OtherGARR MEDICARE
GPA921MedicaidSC

Other names 1

  • Memorial Health Hospitalists Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Provident Health Servic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244073600000",
    "number": "1740341783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 WATERS AVE",
            "address_2": "MEMORIAL HEALTH HOSPITALISTS",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314046220",
            "telephone_number": "912-350-2155",
            "fax_number": "912-350-2156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 WATERS AVE",
            "address_2": "MEMORIAL HEALTH HOSPITALISTS",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314046220",
            "telephone_number": "912-350-2155",
            "fax_number": "912-350-2156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2009-06-04",
        "status": "A",
        "authorized_official_last_name": "MADDOX",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT COORDINATOR",
        "authorized_official_telephone_number": "912-350-9335",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DF7661",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "609293670A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DA3772",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPA921",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Health Hospitalists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2009; 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.