Healthcare Provider Details

I. General information

NPI: 1548350473
Provider Name (Legal Business Name): NORTHPORT MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HOSPITAL DR
NORTHPORT AL
35476-3360
US

IV. Provider business mailing address

809 UNIVERSITY BLVD E
TUSCALOOSA AL
35401-2029
US

V. Phone/Fax

Practice location:
  • Phone: 205-343-8500
  • Fax: 205-759-6397
Mailing address:
  • Phone: 205-759-7190
  • Fax: 205-759-6397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number11874
License Number StateAL

VIII. Authorized Official

Name: KERI H HINDMAN
Title or Position: PATIENT ACCOUNTS DIRECTOR
Credential:
Phone: 205-759-7378