1285783134 NPI number — HOUSTON COUNTY HEALTHCARE AUTHORITY

Table of content: (NPI 1285783134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285783134 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:
1285783134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2007
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:
334-793-8191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1108 ROSS CLARK CIR
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:
36301-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-793-8087
Provider Business Practice Location Address Fax Number:
334-793-8191
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAY
Authorized Official First Name:
REGINA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CONTRACT MANAGER
Authorized Official Telephone Number:
334-793-8087

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: C867 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 558200000 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 311235700 . This is a "FL MCAID CRNA GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 253447900 . This is a "FL MCAID PROFEE/ER GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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