Healthcare Provider Details

I. General information

NPI: 1659566651
Provider Name (Legal Business Name): HOUSTON COUNTY HEALTHCARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 ROSS CLARK CIR
DOTHAN AL
36301-3022
US

IV. Provider business mailing address

PO BOX 1928
DOTHAN AL
36302-1928
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-8087
  • Fax: 334-793-8191
Mailing address:
  • Phone: 334-793-8087
  • Fax: 334-793-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DEREK MILLER
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 334-793-8087