SOUTH CENTRAL PRIMARY CARE CENTER INC. NPI 1295094340

NPI Information

NPI: 1295094340
Provider Name: SOUTH CENTRAL PRIMARY CARE CENTER, INC.

Doing Business As: KIDS HEALTH FITZGERALD

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
299 W BENJAMIN HILL DR
SUITE A
FITZGERALD, GA
ZIP 31750
Phone: (229) 423-5437
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SOUTH CENTRAL PRIMARY CARE CENTER, INC. is a federally qualified health center (fqhc) clinic center in Fitzgerald, GA. SOUTH CENTRAL PRIMARY CARE CENTER, INC. NPI is 1295094340. The provider is registered as an organization entity type.
The provider Is Doing Business As Kids Health Fitzgerald.

The provider's business location address is:

299 W BENJAMIN HILL DR
SUITE A
FITZGERALD, GA
ZIP 31750
Phone: (229) 423-5437

The provider's authorized official is Robert Bonds Tucker .
The authorized official title is Ceo and has the following contact phone number (229) 468-9166.

The enumeration date for this NPI number is 5/10/2012 and was last updated on 1/25/2024.

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	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			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	0003124446A	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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