Healthcare Provider Details

I. General information

NPI: 1083663579
Provider Name (Legal Business Name): FORT PAYNE HOSPITAL ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTRE DR.
FORT PAYNE AL
35968
US

IV. Provider business mailing address

330 FRANKLIN RD
BRENTWOOD TN
37027-3280
US

V. Phone/Fax

Practice location:
  • Phone: 256-845-3150
  • Fax:
Mailing address:
  • Phone: 615-309-3300
  • Fax: 615-309-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID L. MILLER
Title or Position: SR. VP
Credential:
Phone: 615-465-7000