Active NPI
Ear, Nose and Throat Clinic of Coffee Co.
- Specialist
- Douglas, GA
National Provider Identifier
1891750774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 041953
- Legal business name
- EAR, NOSE AND THROAT CLINIC OF COFFEE CO.
- Practice address
- 312 Westside Drive
Douglas, GA 31533-0312 - Phone
- (912) 384-2200
- Fax
- (912) 383-7992
- NPI assigned
- Apr 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Amber Patterson
- Title
- Office Manager
- Phone
- (912) 384-2200
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 041953 | GA | Primary |
Addresses
Primary practice location
312 Westside Drive
Douglas, GA 31533-0312
Mailing address
P.O. Box 1068
Douglas, GA 31533-1068
Phone (912) 384-2200
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DE8251 | Other | GA | MEDICARE RAILROAD GROUP ID |
| 990001864 | Other | GA | MEDICARE RAILROAD |
| 300032501A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050620000687 | GA | Part B Supplier - Clinic/Group Practice | 4486698578 |
Receives reassigned benefits from 16 practitioners Practice locations: Douglas, GA; Waycross, GA; Tifton, GA |
National Provider Directory
National Provider DirectoryLocations
310 Shirley Ave
Douglas, GA 31533
Phone (912) 260-3650
314 Westside Dr
Douglas, GA 31533
1004 Ward St W
Douglas, GA 31533
Phone (912) 384-2252
2016 Pineview Ave
Tifton, GA 31794
Phone (229) 387-9205
1703 Boulevard Sq
Waycross, GA 31501
Practitioners 18
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1265241600000",
"number": "1891750774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 1068",
"city": "DOUGLAS",
"state": "GA",
"postal_code": "315331068",
"telephone_number": "912-384-2200",
"fax_number": "912-383-7992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "312 WESTSIDE DRIVE",
"city": "DOUGLAS",
"state": "GA",
"postal_code": "315330312",
"telephone_number": "912-384-2200",
"fax_number": "912-383-7992"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EAR, NOSE AND THROAT CLINIC OF COFFEE CO.",
"organizational_subpart": "NO",
"enumeration_date": "2006-04-20",
"last_updated": "2010-02-04",
"status": "A",
"authorized_official_last_name": "PATTERSON",
"authorized_official_first_name": "AMBER",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "912-384-2200",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Specialist",
"state": "GA",
"license": "041953",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD GROUP ID",
"identifier": "DE8251",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "990001864",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300032501A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Douglas, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; 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.