NPIMap

Organization Active NPI

Coffee Regional Medical Center

  • Clinic/Center
  • Douglas, GA
National Provider Identifier
1992999205
Registry record updated Aug 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
03941 Issued in GA
Legal business name
COFFEE REGIONAL MEDICAL CENTER
Practice address
1101 Ocilla Rd
Douglas, GA 31533-2207
Phone
(912) 384-1900
Fax
(912) 389-2105
NPI assigned
Aug 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2007

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

Authorized official

Name
Elaine F Lord
Title
Medical Staff Assistant
Phone
(912) 383-5623

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 03941 GA Primary

Addresses

Primary practice location

1101 Ocilla Rd
Douglas, GA 31533-2207

Mailing address

1101 Ocilla Rd
Douglas, GA 31533-2207
Phone (912) 384-1900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040402000287 GA Part B Supplier - Clinic/Group Practice 4587656012 Receives reassigned benefits from 75 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Douglas, GA

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1188345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188345600000",
    "number": "1992999205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 OCILLA RD",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332207",
            "telephone_number": "912-384-1900",
            "fax_number": "912-389-2105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 OCILLA RD",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332207",
            "telephone_number": "912-384-1900",
            "fax_number": "912-389-2105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEE REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-29",
        "last_updated": "2007-08-29",
        "status": "A",
        "authorized_official_last_name": "LORD",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "MEDICAL STAFF ASSISTANT",
        "authorized_official_telephone_number": "912-383-5623"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": "03941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglas, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2007; 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.