Healthcare Provider Details

I. General information

NPI: 1770837395
Provider Name (Legal Business Name): PICKENS COUNTY HEALTH CARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 10TH AVE S W
REFORM AL
35481-0514
US

IV. Provider business mailing address

PO BOX 347
CARROLLTON AL
35447-0347
US

V. Phone/Fax

Practice location:
  • Phone: 205-375-6251
  • Fax: 205-375-9064
Mailing address:
  • Phone: 205-375-6251
  • Fax: 205-375-9064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HENRY W MCELROY
Title or Position: ADMINISTRATOR
Credential:
Phone: 205-367-8111