MCKINNEY MEDICAL CENTER INC NPI 1801057690

NPI Information

NPI: 1801057690
Provider Name: MCKINNEY MEDICAL CENTER INC

Doing Business As: MCKINNEY COMMUNITY HEALTH CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
3919 MAIN ST
FOLKSTON, GA
ZIP 31537
Phone: (912) 496-3426
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MCKINNEY MEDICAL CENTER INC is a federally qualified health center (fqhc) clinic center in Folkston, GA. MCKINNEY MEDICAL CENTER INC NPI is 1801057690. The provider is registered as an organization entity type.
The provider Is Doing Business As Mckinney Community Health Center.

The provider's business location address is:

3919 MAIN ST
FOLKSTON, GA
ZIP 31537-545
Phone: (912) 496-3426
Fax: (912) 287-1568

The provider's authorized official is Ola Smith .
The authorized official title is Ceo and has the following contact phone number (912) 287-0301.

The CLIA number assigned to this NPI record is 11D0993808 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/24/2008 and was last updated on 6/5/2019.

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	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	111908	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	10066125	OTHER	GEORGIA	AMERIGROUP
2	000715415E	MEDICAID	GEORGIA
3	336243	OTHER	GEORGIA	WELLCARE

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: 5/5/2024

NPI Synchronization or Removal

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