Tift Regional Health System Inc.
Organization Active NPI Pharmacy · Tifton, GA
NPI 1962085282 · NPPES record last updated Aug 16, 2022
Key facts
- NPI
- 1962085282
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- Legal business name
- TIFT REGIONAL HEALTH SYSTEM INC.
- Practice address
- 1623 Madison Ave
Tifton, GA 31794-3757 - Phone
- (229) 353-6369
- NPI assigned
- May 4, 2021
- Organization subpart
- No
Authorized official
- Name
- Christopher Dorman
- Title
- President/Ceo
- Phone
- (229) 353-6104
Owned or controlled facilities with NPI records 8
Other NPIs with the same Medicare PAC ID 12
Corporate family (same tax ID) 19
Practitioners 294
-
Ronald Gary Adams, OTR/L, CHT
-
Madhurima Adulla, M.D
-
Ibrahim Al Marei, MD
-
Raymond Alvarez, DO
-
Robert Gregory Anderson, M.D.
-
Taylor M Anderson, PA-A
-
Luanne Ashton, FNP
-
Jerri K Aultman, RD
-
David M Banks, M.D.
-
Jessica Whitehead Beier, M.D.
-
Julie S Bennett, NP
-
Linsey Brooke Bennett, NP-C
-
Garrett Blalock, PA-C
-
Daniel Lock Boatright, CRNA
-
Penny D Booth, CFNP
-
Timantha D Booth, PA
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Tift Regional Health System Inc |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
All facility ownership & control disclosures 8
| Facility | Type | Role | Since |
|---|---|---|---|
| Southwell Medical Sylvia Barr Center |
Hospital | Operational/Managerial Control | Jul 1, 2012 |
| Tift Regional Health System Inc |
Hospital | Operational/Managerial Control | Mar 1, 2019 |
| Southwell Health and Rehabilitation |
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 Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2019 |
| Southwell Medical |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Jul 12, 2012 |
| Southwell Medical Ashburn Primary Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Jul 12, 2012 |
| Southwell Medical |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Jul 12, 2012 |
| Southwell Medical Community Health |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Jul 12, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220413000743 | GA | DME Supplier - Pharmacy | 2062745169 | Practice locations: Tifton, GA |
National Provider Directory
- Tax ID family
- Tift Regional Health System Inc
Locations
1623 Madison Ave
Tifton, GA 31794
Phone (229) 353-7720
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | Yes |
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
- Tift Regional Specialty Pharmacy
Other providers in Tifton, GA
- Tift Regional Health System Inc
- Tift Regional Health System Inc
- Tift Regional Health System Inc
- Tift Regional Health System Inc.
- Tift Regional Health System Inc.
- Tift Regional Health System Inc.
- Tift Regional Health System, Inc
- Tift Regional Health System, Inc
- Tift Regional Health System, Inc.
- Tift Regional Health System, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2022. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.