1093729832 NPI number — GADSDEN REGIONAL MEDICAL CENTER LLC

Table of content: (NPI 1093729832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093729832 NPI number — GADSDEN REGIONAL MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GADSDEN REGIONAL MEDICAL CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GADSDEN REGIONAL HOME MEDICAL EQUIPMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093729832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 404799
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-4799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-494-4585
Provider Business Mailing Address Fax Number:
256-494-4474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 W MEIGHAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GADSDEN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-546-6319
Provider Business Practice Location Address Fax Number:
256-546-2295
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLTSFORD
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, BUSINESS OFFICE SERVICES
Authorized Official Telephone Number:
615-465-7466

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1339 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00057922 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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