Healthcare Provider Details

I. General information

NPI: 1710265418
Provider Name (Legal Business Name): ESCAMBIA COUNTY HEALTH CARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BELLEVILLE AVE
BREWTON AL
36426-1306
US

IV. Provider business mailing address

PO BOX 908
BREWTON AL
36427-0908
US

V. Phone/Fax

Practice location:
  • Phone: 251-809-8439
  • Fax: 251-809-8214
Mailing address:
  • Phone: 251-809-8439
  • Fax: 251-809-8214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STACY HINES
Title or Position: ADMINISTRATOR
Credential:
Phone: 251-809-8429