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Organization Active NPI

Clinch County Hospital Authority

  • Medicare Defined Swing Bed Hospital Unit
  • Homerville, GA
National Provider Identifier
1891738308
Registry record updated Dec 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
032-634 Issued in GA
Legal business name
CLINCH COUNTY HOSPITAL AUTHORITY
Practice address
1050 Valdosta Hwy
Homerville, GA 31634-2418
Phone
(912) 487-5211
Fax
(912) 487-4334
NPI assigned
Jun 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2017

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

Authorized official

Name
Mrs. Angela P. Ammons
Title
Administrator
Phone
(912) 487-5211

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 032-634 GA Primary
Critical Access Hospital 282NC0060X 032-634 GA

Addresses

Primary practice location

1050 Valdosta Hwy
Homerville, GA 31634-2418

Mailing address

1050 Valdosta Hwy
P.O. Box 516
Homerville, GA 31634-2418
Phone (912) 487-5211

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220830003408 GA Part A Provider - Critical Access Hospital 7416849922 Practice locations: Homerville, GA

Hospital certification: CCN 11Z308

Legal name
CLINCH COUNTY HOSPITAL AUTHORITY
Doing business as
CLINCH MEMORIAL HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
1050 Valdosta Hwy
Homerville, GA 31634-9701
Main/Primary Hospital Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kay S Hinson Individual Corporate Officer Jul 1, 2021
Robert Varnedoe Individual Corporate Director Apr 29, 2010
Courtney S Tolle Individual Corporate Officer Jul 1, 2017
Verlin Ritch Individual Corporate Director Jun 4, 2007
Stephanie Stovall Individual Corporate Director Jun 4, 2007
Louis J Cassotta Individual Corporate Officer Dec 8, 2015
Donna B Jones Individual Corporate Officer Jul 1, 2018
Louis Phillips Martin Individual Corporate Officer Jan 1, 2025
Angela Pilkey Ammons Individual Corporate Officer Nov 1, 2017
Cassandra Hughes Individual W-2 Managing EmployeeCfo Apr 29, 2010
Wallace Mincey Individual Corporate Director Jun 4, 2007
Stephen Michael Bush Individual Corporate Officer Jan 1, 2024
Laurie B Webb Individual W-2 Managing Employee Jun 4, 2007
Phillip Cook Individual Contracted Managing EmployeeAdministrator Apr 29, 2010
Melinda Davis Individual W-2 Managing Employee Jun 11, 2012
Minnie Kaye Riley Individual Corporate Officer Jul 1, 2021

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Clinch Memorial HospitalHomerville, GA, CCN 111308 Hospital Operational/Managerial Control Apr 6, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 3

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

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513728000000",
    "number": "1891738308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 VALDOSTA HWY",
            "address_2": "P.O. BOX 516",
            "city": "HOMERVILLE",
            "state": "GA",
            "postal_code": "316342418",
            "telephone_number": "912-487-5211",
            "fax_number": "912-487-4334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 VALDOSTA HWY",
            "city": "HOMERVILLE",
            "state": "GA",
            "postal_code": "316342418",
            "telephone_number": "912-487-5211",
            "fax_number": "912-487-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINCH COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2017-12-20",
        "status": "A",
        "authorized_official_last_name": "AMMONS",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "912-487-5211",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "GA",
            "license": "032-634",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "GA",
            "license": "032-634",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Homerville, GA

Sources for this page

Verify at the official NPI Registry.