McKinney Medical Center Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Folkston, GA
NPI 1801057690 · NPPES record last updated Jun 5, 2019
Key facts
- NPI
- 1801057690
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 111908 (GA)
- Legal business name
- MCKINNEY MEDICAL CENTER INC
- Practice address
- 3919 Main St
Folkston, GA 31537-7545 - Phone
- (912) 496-3426
- Fax
- (912) 287-1568
- NPI assigned
- Jun 24, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- MCKINNEY MEDICAL CENTER INC
Authorized official
- Name
- Ola Smith
- Title
- Ceo
- Phone
- (912) 287-0301
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 6
Practitioners 2
-
Stacy Heather Exum Edgar, ARNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D0993808 | McKinney Medical Center, Inc | Certificate of waiver | May 7, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040430000265 | GA | Part B Supplier - Clinic/Group Practice | 3173432226 |
Receives reassigned benefits from 20 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kingsland, GA; Waycross, GA; Nahunta, GA; Folkston, GA; Alma, GA |
National Provider Directory
- Part of
- McKinney Medical Center Inc
Locations
218 Quarterman St
Waycross, GA 31501
Phone (912) 287-0301
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 111908 | GA | Yes |
Addresses
Primary practice location
3919 Main St
Folkston, GA 31537-7545
Mailing address
218 Quarterman St
Waycross, GA 31501-3547
Phone (912) 287-0301
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 336243 | Other | GA | WELLCARE |
| 000715415E | Medicaid | GA | |
| 10066125 | Other | GA | AMERIGROUP |
Other names
- Mckinney Community Health Center
Other providers in Folkston, GA
- Nancy Lawler
- Hal London
- Robert Duaine Lott
- Erin Lee Macpherson
- Amber Renee Manning
- McKinney Medical Center, Inc.
- Brianna Nettles
- Ginia Patrice O'Steen-Johnson
- Avonda Paul
- Danielle Pautler
All providers in Folkston, GA · Federally Qualified Health Center (FQHC) in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.