Provider Demographics
NPI:1730433152
Name:UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / CNO
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KEPSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MA, RN, CENP
Authorized Official - Phone:706-595-1411
Mailing Address - Street 1:2460 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-6600
Mailing Address - Country:US
Mailing Address - Phone:706-595-1411
Mailing Address - Fax:706-597-5141
Practice Address - Street 1:2460 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-6600
Practice Address - Country:US
Practice Address - Phone:706-595-1411
Practice Address - Fax:706-597-5139
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-07
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty