Basic Information
| Provider Information | |||||||||
| NPI: | 1033428214 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SCREVEN COUNTY HOSPITAL LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OPTIM PRIMARY CARE MILLEN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 MALL BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314064801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126441626 | ||||||||
| FaxNumber: | 9126443369 | ||||||||
| Practice Location | |||||||||
| Address1: | 961 E WINTHROPE AVE | ||||||||
| Address2: | |||||||||
| City: | MILLEN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304421839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789829081 | ||||||||
| FaxNumber: | 4789828843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 05/07/2018 | ||||||||
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| AuthorizedOfficialLastName: | ROLAND | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OPERATIONS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9126445300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | GA | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.