Healthcare Provider Details

I. General information

NPI: 1992793046
Provider Name (Legal Business Name): PICKENS COUNTY MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 ROBERT K WILSON DR
CARROLLTON AL
35447-8010
US

IV. Provider business mailing address

241 ROBERT K WILSON DR P O BOX 478
CARROLLTON AL
35447-8010
US

V. Phone/Fax

Practice location:
  • Phone: 205-367-2100
  • Fax: 205-367-9123
Mailing address:
  • Phone: 205-367-2100
  • Fax: 205-367-9123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number10402
License Number StateAL

VIII. Authorized Official

Name: MR. H WAYNE MCELROY
Title or Position: ADMINISTRATOR
Credential:
Phone: 205-367-2100