Organization
R T STANLEY HEALTH CENTER LLC
Active
Organization
R T STANLEY HEALTH CENTER LLC
Active
Parent organization
SOUTHEAST REGIONAL PRIMARY CARE CORP
Other names
R T STANLEY HEALTH CENTER LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST REGIONAL PRIMARY CARE CORP
Authorized official
TONY M OSTEEN (CFO)
(912) 535-8691
Entity
Organization
Contact information
Practice address
110 RT STANLEY SR PL, LYONS, GA 30436-5623
(912) 526-9355
(912) 526-8622
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 537-4986
(912) 526-8622
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
138-476
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0003111970A
—
GA
01
—
11-8904
MEDICARE ID-TYPE UNSPECIFIED
GA
Enumeration date
08/24/2005
Last updated
08/27/2019
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