PRUITTHEALTH HOSPICE INC NPI 1063450666

NPI Information

NPI: 1063450666
Provider Name: PRUITTHEALTH HOSPICE, INC

Doing Business As: PRUITTHEALTH HOSPICE - VALDOSTA

Classification: Hospice Care, Community Based - 251G00000X
Entity Type: Organization

CLIA Number: 11D2208915

Address:
407 COWART AVE
VALDOSTA, GA
ZIP 31602
Phone: (229) 242-1187
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PRUITTHEALTH HOSPICE, INC is a hospice care community based in Valdosta, GA. PRUITTHEALTH HOSPICE, INC NPI is 1063450666. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Pruitthealth Hospice - Valdosta.

The provider's business location address is:

407 COWART AVE
VALDOSTA, GA
ZIP 31602-635
Phone: (229) 242-1187
Fax: (229) 242-0562

The provider's authorized official is Neil L Pruitt .
The authorized official title is Chairman And Ceo and has the following contact phone number (770) 925-1143.

The CLIA number assigned to this NPI record is 11D2208915 - independent with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/3/2006 and was last updated on 9/15/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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	207RH0002X	Internal Medicine	Hospice and Palliative Medicine			No
2	251G00000X	Hospice Care, Community Based				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00849494A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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