1194811901 NPI number — CRENSHAW COUNTY HEALTH CARE AUTHORITY

Table of content: (NPI 1194811901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194811901 NPI number — CRENSHAW COUNTY HEALTH CARE AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRENSHAW COUNTY HEALTH CARE 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:
CRENSHAW FAMILY CARE CENTER
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:
1194811901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 HOSPITAL CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUVERNE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36049-7344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-335-3374
Provider Business Mailing Address Fax Number:
334-335-1119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58 ROY BEALL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUVERNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36049-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-335-1212
Provider Business Practice Location Address Fax Number:
334-335-1217
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIMBRO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
334-335-3374

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 540003411 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051518337 . This is a "BC PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com