1922044494 NPI number — LISTER HEALTH CARE CORPORATION

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 1922044494 NPI number — LISTER HEALTH CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LISTER HEALTH CARE CORPORATION
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:
1922044494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 298
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35631-0298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-767-7494
Provider Business Mailing Address Fax Number:
256-760-8432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30320 AL HIGHWAY 53 STE B&C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARDMORE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35739-8766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-423-4800
Provider Business Practice Location Address Fax Number:
256-423-8448
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHASE
Authorized Official First Name:
KRISTA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING AGENT
Authorized Official Telephone Number:
256-767-7494

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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