1649313875 NPI number — LIMESTONE COUNTY HEALTH DEPT MAT CM

Table of content: (NPI 1649313875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649313875 NPI number — LIMESTONE COUNTY HEALTH DEPT MAT CM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIMESTONE COUNTY HEALTH DEPT MAT CM
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:
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:
1649313875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 889
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35612-0889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 W ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35611-4802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-232-3200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PATTERSON
Authorized Official First Name:
REGINA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR OF HEALTH SYSTEMS
Authorized Official Telephone Number:
334-206-5061

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 590120052 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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