# EASTSIDE MEDICAL CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Piedmont Eastside Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467406132
- **Authorized official:** ROBERT C CROSS (VP GOVERNMENT REIMBURSEMENT)
- **Authorized official phone:** (470) 271-3401

## Contact information

- **Practice address:** 1700 MEDICAL WAY, SNELLVILLE, GA 30078-2195
- **Practice address phone:** (770) 979-0200
- **Practice address fax:** (770) 736-2395
- **Mailing address:** 1700 MEDICAL WAY, SNELLVILLE, GA 30078-2195
- **Mailing address phone:** (770) 979-0200
- **Mailing address fax:** (770) 736-2395

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | — | NULL | Yes |

## Other

- **Enumeration date:** 05/19/2006
- **Last updated:** 02/26/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00190088A | — | GA |
| 05 | — | 0067598 | — | NJ |
| 05 | — | 0110192 | — | TN |
| 05 | — | 036540100 | — | DC |
| 05 | — | 071850401 | — | TX |
| 05 | — | 1010484 | — | MA |
| 05 | — | 119513 | — | AZ |
| 05 | — | 143405 | — | SC |
| 01 | — | 1526531 | GATEWAY MEDICAID HMO | — |
| 05 | — | 157505105 | — | AR |
| 01 | — | 158328200 | DEPT OF LABOR | — |
| 05 | — | 1633343 | — | NY |
| 05 | — | 200225640A | — | IN |
| 05 | — | 30000595 | — | PA |
| 05 | — | 3022050 | — | WA |
| 05 | — | 308068059 | — | MI |
| 01 | — | 3564 | BLUE CROSS | — |
| 01 | — | 4001267 | BLUE CARE | — |
| 05 | — | 406635900 | — | MD |
| 05 | — | 421810000 | — | ME |
| 05 | — | 50002177 | — | KY |
| 05 | — | 82092 | — | NY |
| 05 | — | 82176800 | — | WI |
| 05 | — | 909638800 | — | FL |
| 05 | — | HOS0192N | — | AL |
| 05 | — | XHSP33294 | — | CA |