GLYNN COUNTY BOARD OF HEALTH (COASTAL HEALTH DISTRICT-BRUNSWICK) - NPI NUMBER 1164429692

Summary

Provider Name: GLYNN COUNTY BOARD OF HEALTH (COASTAL HEALTH DISTRICT-BRUNSWICK)

NPI Number: 1164429692

Clasification: Public Health or Welfare (251K00000X)

Address:
2747 4TH ST
BRUNSWICK, GA
ZIP 31520

Phone Number: (912) 264-3236



Detailed Information

GLYNN COUNTY BOARD OF HEALTH is a public health or welfare in Brunswick, GA. The assigned NPI number for this provider is 1164429692 and is registered as an organization entity type.
The provider Is Doing Business As Coastal Health District-brunswick.

The provider's business address is:

2747 4TH ST
BRUNSWICK, GA
ZIP 31520-714
Phone: (912) 264-3236
Fax: (912) 262-3051

The provider's authorized official is Stacy A. Cooper .
The authorized official title is District Billing Dept. Coordinator and has the following contact phone number (912) 262-2347.

The enumeration date for this NPI number is 6/30/2005 and was last updated on 1/6/2015.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1164503124 CHATHAM COUNTY BOARD OF HEALTH
Public Health or Welfare
1730187188 GLYNN COUNTY BOARD OF HEALTH
Public Health or Welfare
1255339529 GLYNN COUNTY HEATLH DEPARTMENT
Public Health or Welfare





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 251K00000X Public Health or Welfare Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 FLU143 OTHER GA MEDICARE NUMBER
2 GRP1762 MEDICARE PIN GA
3 000456508P MEDICAID GA
4 F30716 MEDICARE UPIN GA

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1164429692 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name GLYNN COUNTY BOARD OF HEALTH The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name COASTAL HEALTH DISTRICT-BRUNSWICK Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 2747 4TH ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name BRUNSWICK The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name GA The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 315203714 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 9122643236 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 9122623051 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 6/30/2005 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 1/6/2015 The date that a record was last updated or changed.
16 Authorized Official Last Name COOPER The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name STACY The first name of the authorized official.
18 Authorized Official Middle Name A. The middle name of the authorized official.
19 Authorized Official Title or Position DISTRICT BILLING DEPT. COORDINATOR The title or position of the authorized official.
20 Authorized Official Telephone Number 9122622347 The 10-position telephone number of the authorized official.
21 Healthcare Provider Taxonomy Code 1 251K00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 FLU143 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier Type Code 1 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier State 1 GA
26 Other Provider Identifier Issuer 1 MEDICARE NUMBER
27 Other Provider Identifier 2 GRP1762 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier Type Code 2 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier State 2 GA
30 Other Provider Identifier 3 000456508P Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier Type Code 3 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
32 Other Provider Identifier State 3 GA
33 Other Provider Identifier 4 F30716 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
34 Other Provider Identifier Type Code 4 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
35 Other Provider Identifier State 4 GA
36 Is Organization Subpart Y
37 Parent Organization LBN GLYNN COUNTY BOARD OF HEALTH
38 Parent Organization TIN

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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