NPIMap

Organization Active NPI

Evans Memorial Hospital

  • Rural Health Clinic/Center
  • Claxton, GA
National Provider Identifier
1760717433
Registry record updated Jul 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EVANS MEMORIAL HOSPITAL
Practice address
602 A E. Long St.
Claxton, GA 30417
Phone
(912) 739-5932
Fax
(912) 739-5933
NPI assigned
Oct 13, 2009
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. John Wiggins
Title
Ceo
Phone
(912) 739-5000

Other NPIs on the same Medicare enrollment 4

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

Corporate family (same tax ID) 5

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

Practitioners 1

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050726000901 GA Part B Supplier - Clinic/Group Practice 0749262905 Receives reassigned benefits from 13 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Claxton, GA

National Provider Directory

National Provider Directory
Tax ID family
Evans Memorial (6 organizations share this tax ID)

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

602 A E. Long St.
Claxton, GA 30417

Mailing address

200 N River St
Claxton, GA 30417-1659
Phone (912) 739-5000

Other names 1

NPPES NPI Registry
  • Evans Family Centered Healthcare North Campus 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 Jul 19, 2011.

{
    "created_epoch": "1255392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311033600000",
    "number": "1760717433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N RIVER ST",
            "city": "CLAXTON",
            "state": "GA",
            "postal_code": "304171659",
            "telephone_number": "912-739-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 A E. LONG ST.",
            "city": "CLAXTON",
            "state": "GA",
            "postal_code": "30417",
            "telephone_number": "912-739-5932",
            "fax_number": "912-739-5933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANS MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-13",
        "last_updated": "2011-07-19",
        "status": "A",
        "authorized_official_last_name": "WIGGINS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-739-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evans Family Centered Healthcare North Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Claxton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; 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.