1275587073 NPI number — THE DCH HEALTH CARE AUTHORITY

Table of content: (NPI 1275587073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275587073 NPI number — THE DCH HEALTH CARE AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DCH HEALTH CARE 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:
1275587073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 DR EDWARD HILLARD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35401-7446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-759-7010
Provider Business Mailing Address Fax Number:
205-330-3147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 DR EDWARD HILLARD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35401-7446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-759-7010
Provider Business Practice Location Address Fax Number:
205-330-3147
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HINDMAN
Authorized Official First Name:
KERI
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PATIENT ACCOUNTS DIRECTOR
Authorized Official Telephone Number:
205-759-7378

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000042376 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51010100000447 . This is a "BLUE CROSS FEDERAL NASCO" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51042376 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51505865 . This is a "BLUE CROSS SHIELD O.T." identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51094872 . This is a "BC BS PHYSICAL THERAPY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 370729 . This is a "BLACK LUNG" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: DCH7080A , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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