1528082336 NPI number — HEALTH SERVICES, INC

Table of content: (NPI 1528082336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528082336 NPI number — HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH SERVICES, 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:
MONTGOMERY PRIMARY CARE
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:
1528082336
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70365
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36107-0365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-263-2301
Provider Business Mailing Address Fax Number:
334-264-4353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3060 MOBILE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36108-4027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-293-6670
Provider Business Practice Location Address Fax Number:
334-293-6676
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEAL
Authorized Official First Name:
SUSIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
334-420-5001

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 630002009 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01D0967315 . This is a "CLIA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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