1023162856 NPI number — LIMESTONE COMMUNITY CARE INC

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 1023162856 NPI number — LIMESTONE COMMUNITY CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIMESTONE COMMUNITY CARE INC
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:
Provider Other Organization Name Type Code:
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:
1023162856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 449
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKMONT
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35620-0449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-732-3712
Provider Business Mailing Address Fax Number:
256-732-3714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25442 AL HIGHWAY 127
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKMONT
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35620-0449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-732-3712
Provider Business Practice Location Address Fax Number:
256-732-3714
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
AUBREY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
256-732-3712

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  19353 , 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: 529912810 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51511593 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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