1609948306 NPI number — SOUTHERN RURAL HEALTH CARE CONSORTIUM, INC.

Table of content: (NPI 1609948306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609948306 NPI number — SOUTHERN RURAL HEALTH CARE CONSORTIUM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN RURAL HEALTH CARE CONSORTIUM, 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:
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:
1609948306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 970
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELLVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35653-0970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-332-1631
Provider Business Mailing Address Fax Number:
256-332-4600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1304 13TH AVENUE S.E.
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-332-1631
Provider Business Practice Location Address Fax Number:
256-332-4600
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
256-332-1631

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , 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)

  • Identifier: 01200280 . This is a "BLUE CROSS BLUE SHIELD AL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 630005001 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01-1902 . This is a "MEDICARE #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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