1174579007 NPI number — DALE MEDICAL CENTER

Table of content: (NPI 1174579007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174579007 NPI number — DALE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALE 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:
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:
1174579007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 41697
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19101-1697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
180-035-5080
Provider Business Mailing Address Fax Number:
610-834-2862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HOSPITAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OZARK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36360-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-774-2601
Provider Business Practice Location Address Fax Number:
334-774-8504
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARLOW
Authorized Official First Name:
CARL
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
334-774-2601

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: 529800820 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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