1720370679 NPI number — THE DCH HEALTH CARE AUTHORITY

Table of content: (NPI 1720370679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720370679 NPI number — THE DCH HEALTH CARE AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DCH 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:
1720370679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
809 UNIVERSITY BLVD E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35401-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-343-8500
Provider Business Mailing Address Fax Number:
205-759-6397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHPORT
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35476-3360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-330-3227
Provider Business Practice Location Address Fax Number:
205-759-6397
Provider Enumeration Date:
05/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HINDMAN
Authorized Official First Name:
KERI
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PATIENT ACCOUNTS DIRECTOR
Authorized Official Telephone Number:
205-759-7378

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  11874 , 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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