Healthcare Provider Details

I. General information

NPI: 1124356563
Provider Name (Legal Business Name): HALE COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 GREENE ST
GREENSBORO AL
36744-2316
US

IV. Provider business mailing address

508 GREENE ST
GREENSBORO AL
36744-2316
US

V. Phone/Fax

Practice location:
  • Phone: 334-624-3024
  • Fax: 334-624-4453
Mailing address:
  • Phone: 334-624-3024
  • Fax: 334-624-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH3301
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberH3301
License Number StateAL

VIII. Authorized Official

Name: THOMAS OGDEN LACKEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 334-624-3024