1760400535 NPI number — THE HEALTH CARE AUTHORITY OF THE CITY OF HUNTSVILLE

Table of content: (NPI 1760400535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760400535 NPI number — THE HEALTH CARE AUTHORITY OF THE CITY OF HUNTSVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HEALTH CARE AUTHORITY OF THE CITY OF HUNTSVILLE
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:
1760400535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 SIVLEY RD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-4421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-801-6012
Provider Business Mailing Address Fax Number:
256-801-6208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 SIVLEY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-533-8362
Provider Business Practice Location Address Fax Number:
256-533-8262
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRAWFORD
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
EXEC DIRECTOR PATIENT FINANCIAL SER
Authorized Official Telephone Number:
256-801-6011

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CC0206 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C849 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529801000 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 529501330 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000811016 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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