Burke Hospital Company
Organization Active NPI Rural Health Clinic/Center · Waynesboro, GA
NPI 1851969372 · NPPES record last updated Oct 3, 2022
Key facts
- NPI
- 1851969372
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- BURKE HOSPITAL COMPANY
- Practice address
- 301 Jones Ave
Waynesboro, GA 30830-1510 - Phone
- (706) 554-4854
- NPI assigned
- Jun 11, 2021
- Organization subpart
- No
Authorized official
- Name
- Michael S Hester
- Title
- Ceo
- Phone
- (912) 369-9400
Owners & managing parties with NPI records 21
-
Brian E Abell, D.O.
-
Terry Lee Arrington, M.D.
-
John Adrian Bojescul, M.D.
-
Justin V Bundy, MD
-
Nicholas Michael Capito, M.D.
-
Johnny F Christian, M.D.
-
John Simpson Clapp, M.D.
-
John H Franklin, MD
-
David Gallagher, MD
-
Kendall M Griffith, M.D.
-
Abraham K Lin, M.D.
-
Matthew Patrick Link, M.D.
-
Randall Miller Meredith, M.D.
-
Ty W Carter, MD
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 17
Related certifications (CCN) 1
Change of ownership 1
Facilities with the same owner 1
Practitioners 8
-
Ashley J Boynton, NP-C
-
David M Doman, M.D.
-
John P George, MD
-
Kendall M Griffith, M.D.
-
William Darrell Hammonds, MD, MPH
-
Jonathan Le, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Rural health clinic certification: CCN 118556
- Legal name
- BURKE HOSPITAL COMPANY
- Doing business as
- BURKE MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 28, 2013
- Last certification
- Jul 5, 2019
- Ownership / control type
- 2B
- Organization structure
- LLC · Proprietary
- Enrollment address
- 301 Jones Ave
Waynesboro, GA 30830-1510 - Related CCNs
- 110113
All disclosed owners & managing parties 23
| Name | Role | Since | Share |
|---|---|---|---|
| Richard William Pope |
Other | Jun 22, 2021 | 3.81% |
| Randall Meredith |
Other | Jun 22, 2021 | 3.81% |
| Nicholas Michael Capito |
Other | Jun 22, 2021 | 3.81% |
| Michael S Hester |
W-2 Managing Employee |
Jun 22, 2021 | |
| John S Clapp |
Other | Jun 22, 2021 | 3.81% |
| Jeremy Jacobs |
Other | Jun 22, 2021 | 3.81% |
| John Bojescul |
Other | Jun 22, 2021 | 3.81% |
| Terry Lee Arrington |
Other | Jun 22, 2021 | 3.81% |
| Brian E Abell |
Other | Jun 22, 2021 | 3.81% |
| Johnny Franklin Christian |
Other | Jun 22, 2021 | 3.81% |
| John H Franklin |
Other | Jun 22, 2021 | 3.81% |
| Joseph P Rectenwald |
Other | Jun 22, 2021 | 3.81% |
| Justin V Bundy |
Other | Jun 22, 2021 | 3.81% |
| Kendall Griffith |
Other | Jun 22, 2021 | 3.81% |
| David Gallagher |
Other | Jun 22, 2021 | 3.81% |
| Abraham King Lin |
Other | Jun 22, 2021 | 3.81% |
| Paul James Herzwurm |
Other | Jun 22, 2021 | 3.81% |
| Richard Vaughan Massie |
Other | Jun 22, 2021 | 3.81% |
| GK Burke, LLC |
5% Or Greater Direct Ownership Interest | Jun 22, 2021 | 20% |
| Julio E Schwarz |
Other | Jun 22, 2021 | 3.81% |
| Ty William Carter |
Other | Jun 22, 2021 | 3.81% |
| Matthew P Link |
Other | Jun 22, 2021 | 3.81% |
| Douglas R Phillips |
Other | Jun 22, 2021 | 3.81% |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jun 22, 2021 | Change of Ownership |
Burke Medical Center Clinic |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210721003588 | GA | Part a Provider - Rural Health Clinic | 3476956012 | Practice locations: Waynesboro, GA |
National Provider Directory
- Tax ID family
- Burke Hospital Company
Locations
301 Jones Ave
Waynesboro, GA 30830
Phone (706) 437-0770
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
301 Jones Ave
Waynesboro, GA 30830-1510
Mailing address
351 S Liberty St
Waynesboro, GA 30830-9686
Other providers in Waynesboro, GA
- Burke Hospital Company
- Burke Hospital Company
- Burke Hospital Company
- Burke Hospital Company
- Burke Hospital Company
- Burke Hospital Company
- Burke Hospital Company
- Victoria Antoinette Burley
- Brandy L Bushatz
- Joshua Cain Sr.
All providers in Waynesboro, GA · Rural Health Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2022. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.