NPIMap

Organization Active NPI

Emanuel County Hospital Authority

Doing business as Emanuel OB/GYN

  • Clinic/Center
  • Swainsboro, GA
National Provider Identifier
1962639807
Registry record updated Feb 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
EMANUEL COUNTY HOSPITAL AUTHORITY
Doing business as
Emanuel OB/GYN
Practice address
125B Victory Dr
Swainsboro, GA 30401-3234
Phone
(478) 289-3190
Fax
(478) 419-1252
NPI assigned
Jun 18, 2009
Last updated
Feb 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2020

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

Authorized official

Name
Owen Tyrell Kelly
Title
Delegated Official
Phone
(478) 289-1192

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

125B Victory Dr
Swainsboro, GA 30401-3234

Mailing address

117 Kite Rd
Swainsboro, GA 30401-3231

Other names 1

  • Emanuel OB/GYN Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040107000256 GA Part B Supplier - Clinic/Group Practice 3577473040 Receives reassigned benefits from 55 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Swainsboro, GA; Vidalia, GA; Soperton, GA; Millen, GA

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Emanuel County Hospital Authority18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

115 S Racetrack St
Swainsboro, GA 30401
Phone (478) 419-1206

Interoperability endpoints

  • Direct secure messaging: roslyn.banksjackson@emc.gadirect.net

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582588800000",
    "number": "1962639807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 KITE RD",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304013231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125B VICTORY DR",
            "city": "SWAINSBORO",
            "state": "GA",
            "postal_code": "304013234",
            "telephone_number": "478-289-3190",
            "fax_number": "478-419-1252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMANUEL COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-18",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "OWEN",
        "authorized_official_middle_name": "TYRELL",
        "authorized_official_title_or_position": "DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "478-289-1192"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emanuel OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Emanuel OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Swainsboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; 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.

Verify at the official NPI Registry.