1104973353 NPI number — NORTHEAST ALABAMA HEALTH SERVICES, INC.

Table of content: (NPI 1104973353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104973353 NPI number — NORTHEAST ALABAMA HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST ALABAMA HEALTH SERVICES, 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:
NORTHEAST ALABAMA HEALTH SERVICES INC - FYFFE
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:
1104973353
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34617 AL HIGHWAY 75
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FYFFE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35971-3488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-623-5242
Provider Business Mailing Address Fax Number:
256-623-5243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34617 AL HIGHWAY 75
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FYFFE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35971-3488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-623-5242
Provider Business Practice Location Address Fax Number:
256-623-5243
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CULPEPPER
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
256-259-5313

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: I990 . This is a "STATE MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 012340 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 630008003 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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