1851388557 NPI number — EASTERN HEALTH SYSTEMS INC

Table of content: (NPI 1851388557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851388557 NPI number — EASTERN HEALTH SYSTEMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN HEALTH SYSTEMS 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:
MEDICAL CENTER BLOUNT EMERGENCY DEPARTMENT
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:
1851388557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11407 LOCKBOX 1066
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-437-6098
Provider Business Mailing Address Fax Number:
205-437-5998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 GILBREATH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONEONTA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35121-2827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-264-9098
Provider Business Practice Location Address Fax Number:
205-437-5998
Provider Enumeration Date:
09/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
205-274-3001

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 529919550 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: F858 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 20477400 . This is a "BLACK LUNG - DPT OF LABOR" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 020477400 . This is a "DEPT OF LABOR (OWCP)" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: CH1298 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 3901711 . This is a "UNITED HEALTHCARE OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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