Healthcare Provider Details

I. General information

NPI: 1073234852
Provider Name (Legal Business Name): JOHN WHITEHURST BILLING PROVIDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 W REYNOLDS ST
OZARK AL
36360-1438
US

IV. Provider business mailing address

110 JAMES ST
OZARK AL
36360-2032
US

V. Phone/Fax

Practice location:
  • Phone: 334-694-1200
  • Fax:
Mailing address:
  • Phone: 334-694-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246YC3301X
TaxonomyHospital Based Coding Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code246YC3302X
TaxonomyPhysician Office Based Coding Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: