Basic Information
| Provider Information | |||||||||
| NPI: | 1437135902 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AU MEDICAL CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 15TH ST | ||||||||
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| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309120004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067210211 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1120 15TH ST | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309120004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067210211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 02/12/2020 | ||||||||
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| AuthorizedOfficialLastName: | KEEFER | ||||||||
| AuthorizedOfficialFirstName: | KATRINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7067216569 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 011-104 | GA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 358127 | 05 | SC | MEDICAID | 315846 | 05 | SC | MEDICAID | 00000723A | 05 | GA | MEDICAID | 000418 | 01 | GA | BLUE CROSS | OTHER |