1124073879 NPI number — ESCAMBIA COUNTY ALABAMA COMMUNITY HOSPITALS, INC

Table of content: (NPI 1124073879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124073879 NPI number — ESCAMBIA COUNTY ALABAMA COMMUNITY HOSPITALS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESCAMBIA COUNTY ALABAMA COMMUNITY HOSPITALS, 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:
ATMORE COMMUNITY HOSPITAL
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:
1124073879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 MEDICAL PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATMORE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36502-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-368-6362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATMORE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36502-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-368-6362
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOWERY
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
251-368-6362

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NR1301X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500002 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 5006840 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10233400 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10572 . This is a "VISTA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: BH3 . This is a "HEALTH OPTIONS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: HOS0053H . This is a "ALACAID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 132 . This is a "PRIME HEALTH OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 100852400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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