1851323836 NPI number — FAYETTE MEDICAL CENTER

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 1851323836 NPI number — FAYETTE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAYETTE MEDICAL CENTER
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:
FAYETTE COUNTY HOSPITAL
Provider Other Organization Name Type Code:
4
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:
1851323836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
809 UNIVERSITY BLVD E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35401-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-759-7190
Provider Business Mailing Address Fax Number:
205-750-5648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1653 TEMPLE AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-932-5966
Provider Business Practice Location Address Fax Number:
205-932-1260
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HINDMAN
Authorized Official First Name:
KERI
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PATIENT ACCCOUNTS DIRECTOR
Authorized Official Telephone Number:
205-759-7378

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: H2901 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010124 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 558200720 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510C858 . This is a "BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 9195 . This is a "HEALTHSPRINGS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: A3555501 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C858 . This is a "BLUE SHIELD MED B" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: HOS0045H , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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