NPIMap

Organization Active NPI

McKinney Medical Center Inc

Doing business as Mckinney Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Folkston, GA
National Provider Identifier
1801057690
Registry record updated Jun 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
111908 Issued in GA
Legal business name
MCKINNEY MEDICAL CENTER INC
Doing business as
Mckinney Community Health Center
Practice address
3919 Main St
Folkston, GA 31537-7545
Phone
(912) 496-3426
Fax
(912) 287-1568
NPI assigned
Jun 24, 2008
Last updated
Jun 5, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MCKINNEY MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 5, 2019

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

Authorized official

Name
Ola Smith
Title
Ceo
Phone
(912) 287-0301

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 111908 GA Primary

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 names 1

  • Mckinney Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801057690. Details of each certification follow.

  • CCN 111908 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 111908

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MCKINNEY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 29, 2008
Last certification
May 29, 2008
Ownership / control type
For profit – corporation
Facility address
3919 Main Street
Folkston, GA 31537

Other NPIs on the same Medicare enrollment 6

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

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
11D0993808McKinney Medical Center, Inc3919 Main Street, Folkston, GA 31537Certificate of waiverMay 7, 2028

National Provider Directory

National Provider Directory
Part of
McKinney Community Heal

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559692800000",
    "number": "1801057690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 QUARTERMAN ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315013547",
            "telephone_number": "912-287-0301",
            "fax_number": "912-287-0687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3919 MAIN ST",
            "city": "FOLKSTON",
            "state": "GA",
            "postal_code": "315377545",
            "telephone_number": "912-496-3426",
            "fax_number": "912-287-1568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKINNEY MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCKINNEY MEDICAL CENTER INC",
        "enumeration_date": "2008-06-24",
        "last_updated": "2019-06-05",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "OLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-287-0301"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "GA",
            "license": "111908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mckinney Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Folkston, GA

Sources for this page

Verify at the official NPI Registry.