Effingham Hospital, Inc.
Organization Active NPI Clinic/Center · Port Wentworth, GA
NPI 1891925608 · NPPES record last updated Nov 29, 2016
Key facts
- NPI
- 1891925608
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- EFFINGHAM HOSPITAL, INC.
- Practice address
- 7306 Ga Highway 21
Ste 105
Port Wentworth, GA 31407-9275 - Phone
- (912) 966-2575
- Fax
- (912) 966-0906
- NPI assigned
- Jul 15, 2009
- Organization subpart
- No
Authorized official
- Name
- Mrs. Francine Baker-Witt, RN, MBA, CNHA
- Title
- Interim Ceo
- Phone
- (912) 754-0142
Other NPIs on the same Medicare enrollment 14
Corporate family (same tax ID) 13
Practitioners 1
-
Jessica Pimentel, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170113001163 | GA | Part B Supplier - Clinic/Group Practice | 1254628092 |
Receives reassigned benefits from 35 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Guyton, GA; Port Wentworth, GA; Rincon, GA; Springfield, GA |
National Provider Directory
- Tax ID family
- Effingham Health System
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | GA | Yes |
Addresses
Primary practice location
7306 Ga Highway 21
Ste 105
Port Wentworth, GA 31407-9275
Mailing address
459 Highway 119 South
Attn.: Alia Allen/Medical Staff Office
Springfield, GA 31329
Phone (912) 754-0175
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HOSP150 | Other | GA | MEDICARE |
Other names
- Effingham Family Medicine at Port Wentworth
Other providers in Port Wentworth, GA
- Dr Kenneith Durden Outreach
- Addie Elaine Duncan
- Aundra J Duncan
- Kenneith Durden
- Effingham Hospital, Inc.
- Elevate Applied Behavior Analysis Consulting LLC
- Exceptional Medical Services LLC
- Family and Children Support, Inc
- Stefanie Lyn Fario
- Georgia CVS Pharmacy, L.L.C.
All providers in Port Wentworth, GA · 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 Nov 29, 2016. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.