Healthcare Provider Details

I. General information

NPI: 1003943531
Provider Name (Legal Business Name): GENEVA COUNTY HEALTHCARE AUTHORITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W MAPLE AVE
GENEVA AL
36340
US

IV. Provider business mailing address

1200 W MAPLE AVE
GENEVA AL
36340-1642
US

V. Phone/Fax

Practice location:
  • Phone: 334-684-3655
  • Fax: 334-684-6564
Mailing address:
  • Phone: 334-684-3655
  • Fax: 334-684-6564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number11807
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANET SMITH
Title or Position: CEO
Credential:
Phone: 334-684-3655