Healthcare Provider Details

I. General information

NPI: 1023061496
Provider Name (Legal Business Name): CRESTWOOD HEALTHCARE LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR SW
HUNTSVILLE AL
35801-6455
US

IV. Provider business mailing address

PO BOX 849007
DALLAS TX
75284-9007
US

V. Phone/Fax

Practice location:
  • Phone: 256-882-3100
  • Fax: 256-880-4246
Mailing address:
  • Phone: 256-882-3100
  • Fax: 256-880-4246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License NumberH4501
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberH4501
License Number StateAL

VIII. Authorized Official

Name: PAULA M LALOR
Title or Position: DIRECTOR
Credential:
Phone: 629-215-3953