Provider Demographics
NPI:1255606216
Name:CRISP REGIONAL HOSPITAL
Entity type:Organization
Organization Name:CRISP REGIONAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHYSICIAN PRACTICES
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-271-4676
Mailing Address - Street 1:910 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-3254
Mailing Address - Country:US
Mailing Address - Phone:229-276-3038
Mailing Address - Fax:229-276-3150
Practice Address - Street 1:910 N 5TH ST
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3254
Practice Address - Country:US
Practice Address - Phone:229-276-3038
Practice Address - Fax:229-276-3150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRISP REGIONAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty