1063567329 NPI number — HOUSTON COUNTY HEALTHCARE AUTHORITY

Table of content: (NPI 1063567329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063567329 NPI number — HOUSTON COUNTY HEALTHCARE AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUSTON COUNTY HEALTHCARE AUTHORITY
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:
1063567329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1388
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36302-1388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-393-5010
Provider Business Mailing Address Fax Number:
334-393-5013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1109 BOLL WEEVILL CIRCLE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
ENTERPRISE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36330-2063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-393-5010
Provider Business Practice Location Address Fax Number:
334-393-5013
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COCHRAN
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
334-712-3311

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51543257 . This is a "BCBS AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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