Healthcare Provider Details

I. General information

NPI: 1982951893
Provider Name (Legal Business Name): NORTH EAST ALABAMA REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 LEIGHTON AVE
ANNISTON AL
36207-5761
US

IV. Provider business mailing address

731 LEIGHTON AVE P.O. BOX 2208
ANNISTON AL
36207-5761
US

V. Phone/Fax

Practice location:
  • Phone: 256-235-5688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPTA6494
License Number StateAL

VIII. Authorized Official

Name: LISA JENKINS
Title or Position: REHABILITATION DIRECTOR
Credential: P.T.
Phone: 256-235-5688