1396125258 NPI number — D W MCMILLAN MEMORIAL HOSPITAL

Table of content: (NPI 1396125258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396125258 NPI number — D W MCMILLAN MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
D W MCMILLAN MEMORIAL HOSPITAL
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:
1396125258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 397
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASTLEBERRY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36432-0397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-966-4600
Provider Business Mailing Address Fax Number:
251-966-7433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1674 CLEVELAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLEBERRY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-966-3400
Provider Business Practice Location Address Fax Number:
251-966-7433
Provider Enumeration Date:
06/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFIN
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
251-809-8398

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  17245 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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