1992851752 NPI number — CLAY COUNTY HEALTHCARE AUTHORITY

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 1992851752 NPI number — CLAY COUNTY HEALTHCARE AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAY COUNTY HEALTHCARE AUTHORITY
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:
CLAY COUNTY HOSPITAL SWING BED
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:
1992851752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36251-1270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-354-2131
Provider Business Mailing Address Fax Number:
256-354-1230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83825 HIGHWAY 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36251-1270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-354-2131
Provider Business Practice Location Address Fax Number:
256-354-1230
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
BROOKE
Authorized Official Title or Position:
DIRECTOR OF CARE COORDINATION/UR
Authorized Official Telephone Number:
256-354-2131

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010505 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 010112 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 479073OS , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00734 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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