Healthcare Provider Details

I. General information

NPI: 1598710980
Provider Name (Legal Business Name): MONROE COUNTY HEALTH CARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 S ALABAMA AVE
MONROEVILLE AL
36460
US

IV. Provider business mailing address

PO BOX 886
MONROEVILLE AL
36461-0886
US

V. Phone/Fax

Practice location:
  • Phone: 251-575-9366
  • Fax: 251-575-3945
Mailing address:
  • Phone: 251-575-9366
  • Fax: 251-575-3945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number244
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number244
License Number StateAL

VIII. Authorized Official

Name: MR. CHARLES WESLEY NALL
Title or Position: CEO
Credential:
Phone: 251-575-3111