BACCHUS OPERATIONS GROUP INC. NPI 1518026202

NPI Information

NPI: 1518026202
Provider Name: BACCHUS OPERATIONS GROUP, INC.
Classification: Clinic/Center - 261QR1300X
Specialization: Rural Health
Entity Type: Organization
Doing Business As: FLINT RIVER RURAL HEALTH CLINIC - ELLAVILLE
CLIA Number: 11D0263731
Address: 509 SUMTER STREET
MONTEZUMA, GA
ZIP 31063
Phone: (478) 472-3100

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NPI Details

BACCHUS OPERATIONS GROUP, INC. is a rural health clinic center in Montezuma, GA. BACCHUS OPERATIONS GROUP, INC. NPI is 1518026202. The provider is registered as an organization entity type.
The provider Is Doing Business As Flint River Rural Health Clinic - Ellaville.

The provider's business location address is:

509 SUMTER STREET
MONTEZUMA, GA
ZIP 31063-733
Phone: (478) 472-3100
Fax: (478) 472-2412

The provider's authorized official is Philip H Eastman .
The authorized official title is Chief Executive Officer and has the following contact phone number (478) 472-3100.

The CLIA number assigned to this NPI record is 11D0263731 - hospital with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/8/2006 and was last updated on 3/23/2012.

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	261QR1300X	Clinic/Center	Rural Health	094-391	GEORGIA	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	000149487B	MEDICAID	GEORGIA
2	113404	MEDICARE ID-TYPE UNSPECIFIED	GEORGIA	PROVIDER NUMBER

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: 3/30/2025

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