1558464511 NPI number — HALE COUNTY HOSPITAL

Table of content: (NPI 1558464511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558464511 NPI number — HALE COUNTY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HALE COUNTY HOSPITAL
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:
HALE COUNTY HOSPITAL CLINIC
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:
1558464511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 614
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-624-4442
Provider Business Mailing Address Fax Number:
334-624-1405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 GREENE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36744-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-624-4442
Provider Business Practice Location Address Fax Number:
334-624-1405
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LACKEY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
O
Authorized Official Title or Position:
ADMINISTRATOR/CEO
Authorized Official Telephone Number:
334-624-3024

Provider Taxonomy Codes

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

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

  • Identifier: 529303070 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121780 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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