NPIMap

Organization Active NPI

Phoebe Putney Memorial Hospital, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Albany, GA
National Provider Identifier
1871697508
Registry record updated Jun 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
16760 Issued in GA
Legal business name
PHOEBE PUTNEY MEMORIAL HOSPITAL, INC.
Practice address
427 W Third Avenue
Albany, GA 31701
Phone
(229) 312-0042
Fax
(229) 312-0045
NPI assigned
Sep 12, 2006
Organization subpart
Yes
Parent organization
PHOEBE PUTNEY MEMORIAL HOSPITAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 7, 2018

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

Authorized official

Name
Brian Allen Church
Title
Cfo
Phone
(229) 312-4068

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 16760 GA Primary

Addresses

Primary practice location

427 W Third Avenue
Albany, GA 31701

Mailing address

427 W Third Avenue
Albany, GA 31701-1943
Phone (229) 312-0042

Other identifiers 2

IdentifierTypeStateIssuer
00932489AMedicaidGA
00932489BMedicaidGA

Other names 1

  • Phoebe Cancer Center Boutique Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930015048 GA DME Supplier - Medical Supply CompanyDME Supplier - Medical Supply Company With Prosthetic Personnel 4486559549 Practice locations: Albany, GA

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Phoebe Putney Memorial30 organizations share this tax ID, including this one
Part of
Phoebe Putney Memorial

Other organizations with this tax ID 29

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

View all 29

Locations

2000 Palmyra Rd
Fl First
Albany, GA 31701

Practitioners & affiliated clinicians

Practitioners 75

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

View all 75

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528329600000",
    "number": "1871697508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 W THIRD AVENUE",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011943",
            "telephone_number": "229-312-0042",
            "fax_number": "229-312-0045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 W THIRD AVENUE",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "31701",
            "telephone_number": "229-312-0042",
            "fax_number": "229-312-0045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOEBE PUTNEY MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHOEBE PUTNEY MEMORIAL HOSPITAL, INC",
        "enumeration_date": "2006-09-12",
        "last_updated": "2018-06-07",
        "status": "A",
        "authorized_official_last_name": "CHURCH",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "229-312-4068"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "16760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00932489A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00932489B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoebe Cancer Center Boutique",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Phoebe Cancer Center Boutique",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albany, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; 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.