NPIMap

Organization Active NPI

Tift Regional Health System Inc.

Doing business as Tift Regional Specialty Pharmacy

  • Pharmacy
  • Tifton, GA
National Provider Identifier
1962085282
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
TIFT REGIONAL HEALTH SYSTEM INC.
Doing business as
Tift Regional Specialty Pharmacy
Practice address
1623 Madison Ave
Tifton, GA 31794-3757
Phone
(229) 353-6369
NPI assigned
May 4, 2021
Last updated
Aug 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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

Authorized official

Name
Christopher Dorman
Title
President/Ceo
Phone
(229) 353-6104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary

Addresses

Primary practice location

1623 Madison Ave
Tifton, GA 31794-3757

Mailing address

PO Box 2650
Tifton, GA 31793-2650
Phone (229) 353-3422

Other names 1

  • Tift Regional Specialty Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220413000743 GA DME Supplier - Pharmacy 2062745169 Practice locations: Tifton, GA

Other NPIs with the same Medicare PAC ID 12

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Tift Regional Health System Inc1623 Madison Ave, Tifton, GA 31794-3757(229) 353-6369 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Aug 1, 2019

National Provider Directory

National Provider Directory
Tax ID family
Southwell Pharmacy21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 8

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

FacilityTypeRoleSince
Southwell Medical Sylvia Barr CenterAdel, GA, CCN 11S101 Hospital Operational/Managerial Control Jul 1, 2012
Tift Regional Health System IncTifton, GA, CCN 110095 Hospital Operational/Managerial Control Mar 1, 2019
Southwell Health and RehabilitationAdel, GA, CCN 115655 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF
Direct Ownership Interest (100%)		 Mar 1, 2019
Mar 1, 2019
May 15, 2025
Mar 1, 2019
Southwell Medical Adel Primary CareAdel, GA, CCN 118528 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2019
Southwell MedicalSylvester, GA, CCN 118578 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 12, 2012
Southwell Medical Ashburn Primary CareAshburn, GA, CCN 118574 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 12, 2012
Southwell MedicalNashville, GA, CCN 118577 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 12, 2012
Southwell Medical Community HealthTifton, GA, CCN 118576 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 12, 2012

Owned or controlled facilities with NPI records 8

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

NPI Registry JSON

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

{
    "created_epoch": "1620086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1962085282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2650",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317932650",
            "telephone_number": "229-353-3422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1623 MADISON AVE",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943757",
            "telephone_number": "229-353-6369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIFT REGIONAL HEALTH SYSTEM INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-04",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "DORMAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "229-353-6104"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tift Regional Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tift Regional Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tifton, GA

Sources for this page

Verify at the official NPI Registry.