1598710980 NPI number — MONROE COUNTY HEALTH CARE AUTHORITY

Table of content: (NPI 1598710980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598710980 NPI number — MONROE COUNTY HEALTH CARE AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONROE COUNTY 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:
1598710980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 886
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36461-0886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-575-9366
Provider Business Mailing Address Fax Number:
251-575-3945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2016 S ALABAMA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROEVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-575-9366
Provider Business Practice Location Address Fax Number:
251-575-3945
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NALL
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
WESLEY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
251-575-3111

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  244 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , with the licence number: 244 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100001002 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009708180 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51503942 . This is a "BLUE CROSS HME PROVIDER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51047025 . This is a "BLUE CROSS HHA PROVIDER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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