1225382898 NPI number — PICKENS COUNTY HEALTH CARE 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 1225382898 NPI number — PICKENS COUNTY HEALTH CARE AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PICKENS 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:
Provider Other Organization Name Type Code:
6
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:
1225382898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35447-0127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-367-1192
Provider Business Mailing Address Fax Number:
205-367-1943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 ROBERT K WILSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35447-0241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-367-1192
Provider Business Practice Location Address Fax Number:
205-367-1943
Provider Enumeration Date:
11/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MCELROY
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
UNIT LEADER PHYSICIAN SERVICES
Authorized Official Telephone Number:
205-367-8111

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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