Healthcare Provider Details

I. General information

NPI: 1548809403
Provider Name (Legal Business Name): MIZELL MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2019
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E MEMORIAL AVE STE A
OPP AL
36467-1746
US

IV. Provider business mailing address

PO BOX 1010
OPP AL
36467-1010
US

V. Phone/Fax

Practice location:
  • Phone: 334-493-5555
  • Fax: 334-493-0517
Mailing address:
  • Phone: 334-493-3541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JANA WYATT
Title or Position: CEO / CFO
Credential:
Phone: 334-493-9111