NPIMap

Organization Active NPI

Crisp Regional Hospital, Inc.

Doing business as Rochelle Healthcare Clinic

  • Rural Health Clinic/Center
  • Rochelle, GA
National Provider Identifier
1902013048
Registry record updated May 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CRISP REGIONAL HOSPITAL, INC.
Doing business as
Rochelle Healthcare Clinic
Practice address
636 Second Avenue, SW
Rochelle, GA 31079
Phone
(229) 365-2570
Fax
(229) 365-2571
NPI assigned
May 17, 2007
Last updated
May 27, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
CRISP REGIONAL HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 27, 2008

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

Authorized official

Name
James Miller
Title
Director Physician Practices
Phone
(229) 271-4676

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X GA Primary

Addresses

Primary practice location

636 Second Avenue, SW
Rochelle, GA 31079

Mailing address

636 Second Avenue, SW
Rochelle, GA 31079
Phone (229) 365-2570

Other identifiers 1

IdentifierTypeStateIssuer
00000514HMedicaidGA

Other names 1

  • Rochelle Healthcare Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Surgical Associates22 organizations share this tax ID, including this one
Part of
Surgical Associates

Other organizations with this tax ID 21

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

View all 21

Locations

636 2nd Ave
Rochelle, GA 31079
Phone (229) 365-2570

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211846400000",
    "number": "1902013048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 SECOND AVENUE, SW",
            "city": "ROCHELLE",
            "state": "GA",
            "postal_code": "31079",
            "telephone_number": "229-365-2570",
            "fax_number": "229-365-2571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 SECOND AVENUE, SW",
            "city": "ROCHELLE",
            "state": "GA",
            "postal_code": "31079",
            "telephone_number": "229-365-2570",
            "fax_number": "229-365-2571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRISP REGIONAL HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRISP REGIONAL HOSPITAL, INC.",
        "enumeration_date": "2007-05-17",
        "last_updated": "2008-05-27",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "DIRECTOR PHYSICIAN PRACTICES",
        "authorized_official_telephone_number": "229-271-4676"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00000514H",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rochelle Healthcare Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rochelle, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.