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
1730187188 GLYNN COUNTY BOARD OF HEALTH
Public Health or Welfare
1164503124 CHATHAM 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
1 NPI 1164429692
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name GLYNN COUNTY BOARD OF HEALTH
5 Provider Other Organization Name COASTAL HEALTH DISTRICT-BRUNSWICK
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 2747 4TH ST
8 Provider Business Practice Location Address City Name BRUNSWICK
9 Provider Business Practice Location Address State Name GA
10 Provider Business Practice Location Address Postal Code 315203714
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 9122643236
13 Provider Business Practice Location Address Fax Number 9122623051
14 Provider Enumeration Date 6/30/2005
15 Last Update Date 1/6/2015
16 Authorized Official Last Name COOPER
17 Authorized Official First Name STACY
18 Authorized Official Middle Name A.
19 Authorized Official Title or Position DISTRICT BILLING DEPT. COORDINATOR
20 Authorized Official Telephone Number 9122622347
21 Healthcare Provider Taxonomy Code 1 251K00000X
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 FLU143
24 Other Provider Identifier Type Code 1 01
25 Other Provider Identifier State 1 GA
26 Other Provider Identifier Issuer 1 MEDICARE NUMBER
27 Other Provider Identifier 2 GRP1762
28 Other Provider Identifier Type Code 2 08
29 Other Provider Identifier State 2 GA
30 Other Provider Identifier 3 000456508P
31 Other Provider Identifier Type Code 3 05
32 Other Provider Identifier State 3 GA
33 Other Provider Identifier 4 F30716
34 Other Provider Identifier Type Code 4 02
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: 2/10/2015
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.