NPIMap

Organization Active NPI

Hospital Authority of Valdosta and Lowndes County, Georgia

  • General Acute Care Hospital
  • Valdosta, GA
National Provider Identifier
1780023911
Registry record updated Jun 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
092-141 Issued in GA
Legal business name
HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY, GEORGIA
Practice address
4280 N Valdosta Rd
Valdosta, GA 31602-6814
Phone
(229) 433-8000
NPI assigned
Jun 20, 2013
Organization subpart
Yes
Parent organization
HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY, GEORGIAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 4, 2014

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

Authorized official

Name
Mr. Jack Randall Sauls
Title
Chief Executive Officer
Phone
(229) 333-1020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 092-141 GA Primary

Addresses

Primary practice location

4280 N Valdosta Rd
Valdosta, GA 31602-6814

Mailing address

PO Box 0070
Valdosta, GA 31603-0070
Phone (229) 433-8000

Other identifiers 1

IdentifierTypeStateIssuer
000001724GMedicaidGA

Other names 1

  • Smith Northview Hospital, A Campus of South Georgia Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040405001313 GA Part B Supplier - Clinic/Group Practice 1355334509 Receives reassigned benefits from 114 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Valdosta, GA; Nashville, GA; Lakeland, GA

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Part of
Southe Georgia Medical

Locations

4280 N Valdosta Rd
Valdosta, GA 31602
Phone (229) 433-7350

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1371686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401840000000",
    "number": "1780023911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 0070",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316030070",
            "telephone_number": "229-433-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4280 N VALDOSTA RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316026814",
            "telephone_number": "229-433-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY, GEORGIA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY, GEORGIA",
        "enumeration_date": "2013-06-20",
        "last_updated": "2014-06-04",
        "status": "A",
        "authorized_official_last_name": "SAULS",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "RANDALL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "229-333-1020",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "GA",
            "license": "092-141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000001724G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smith Northview Hospital, A Campus of South Georgia Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2014; 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.