Healthcare Provider Details

I. General information

NPI: 1871679993
Provider Name (Legal Business Name): FAYETTE MEDICAL CENTER HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 FAYETTE SQ
FAYETTE AL
35555-1723
US

IV. Provider business mailing address

PO BOX 710 1653 TEMPLE AVENUE NORTH
FAYETTE AL
35555-0710
US

V. Phone/Fax

Practice location:
  • Phone: 205-932-5961
  • Fax: 205-932-8054
Mailing address:
  • Phone: 205-932-5961
  • Fax: 205-932-8054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KERI HENLEY HINDMAN
Title or Position: PATIENT ACCOUNTS DIRECTOR
Credential:
Phone: 205-759-7378