1285097477 NPI number — HOUSTON COUNTY HEALTHCARE AUTHORITY

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 1285097477 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:
1285097477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1928
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:
36302-1928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-793-8087
Provider Business Mailing Address Fax Number:
334-793-8087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1812 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-794-2825
Provider Business Practice Location Address Fax Number:
334-793-5050
Provider Enumeration Date:
04/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
DEREK
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
334-793-8111

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 153687 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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