1326288770 NPI number — DECATUR GENERAL HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326288770 NPI number — DECATUR GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DECATUR GENERAL HOSPITAL
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:
THE HEALTHCARE AUTHORITY OF MORGAN COUNTY
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:
1326288770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35609-2239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-341-2000
Provider Business Mailing Address Fax Number:
256-306-1691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2205 BELTLINE RD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35601-3617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-341-2010
Provider Business Practice Location Address Fax Number:
256-306-1691
Provider Enumeration Date:
02/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BONETTI
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
Authorized Official Title or Position:
EXE DIR, REVENUE CYC
Authorized Official Telephone Number:
256-265-9641

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  11859 , 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: 010-824 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: HOS0085H , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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