1760639702 NPI number — THE HEALTH CARE AUTHORITY OF LAUDERDALE COUNTY AND THE CITY OF FLORENC

Table of content: (NPI 1760639702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760639702 NPI number — THE HEALTH CARE AUTHORITY OF LAUDERDALE COUNTY AND THE CITY OF FLORENC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HEALTH CARE AUTHORITY OF LAUDERDALE COUNTY AND THE CITY OF FLORENC
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:
1760639702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10005
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35631-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-768-9191
Provider Business Mailing Address Fax Number:
256-768-8774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 AVALON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSCLE SHOALS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35661-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-386-1600
Provider Business Practice Location Address Fax Number:
256-768-8774
Provider Enumeration Date:
08/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PIGG
Authorized Official First Name:
JODY
Authorized Official Middle Name:
LEWIS
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
256-768-9191

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  H3902 , 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: 529904540 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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