1457418659 NPI number — NORTHEAST ALABAMA HEALTH SERVICES, INC.

Table of content: (NPI 1457418659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457418659 NPI number — NORTHEAST ALABAMA HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST ALABAMA HEALTH SERVICES, INC.
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:
NORTHEAST ALABAMA HEALTH SERVICES INC - SECTION
Provider Other Organization Name Type Code:
3
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:
1457418659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 MAIN ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SECTION
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35771-7168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-228-3471
Provider Business Mailing Address Fax Number:
256-228-7289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 MAIN ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SECTION
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35771-7168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-228-3471
Provider Business Practice Location Address Fax Number:
256-228-7289
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
256-259-5313

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010969 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 630002003 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: D515 . This is a "STATE MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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