1851323836 NPI number — FAYETTE MEDICAL CENTER

Table of content: (NPI 1851323836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851323836 NPI number — FAYETTE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAYETTE MEDICAL CENTER
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:
1851323836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2022
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:
205-759-7190
Provider Business Mailing Address Fax Number:
205-750-5648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1653 TEMPLE AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-932-5966
Provider Business Practice Location Address Fax Number:
205-932-1260
Provider Enumeration Date:
07/07/2006

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 ACCCOUNTS DIRECTOR
Authorized Official Telephone Number:
205-759-7378

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: H2901 , 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: 010124 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 558200720 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510C858 . This is a "BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 9195 . This is a "HEALTHSPRINGS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: A3555501 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C858 . This is a "BLUE SHIELD MED B" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: HOS0045H , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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