Organization
BACCHUS OPERATIONS GROUP, INC.
Active
Organization
BACCHUS OPERATIONS GROUP, INC.
Active
Other names
Flint River Rural Health Clinic - Ellaville
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILIP H EASTMAN III (CHIEF EXECUTIVE OFFICER)
(478) 472-3100
Entity
Organization
Contact information
Practice address
509 SUMTER STREET, MONTEZUMA, GA 31063-1733
(478) 472-3100
(478) 472-2412
Mailing address
509 SUMTER STREET, PO BOX 770, MONTEZUMA, GA 31063-1733
(478) 472-3100
(478) 472-2412
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
094-391
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000149487B
—
GA
Enumeration date
12/08/2006
Last updated
03/23/2012
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up