Healthcare Provider Details

I. General information

NPI: 1275591992
Provider Name (Legal Business Name): ROANOKE HEALTHCARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59928 HIGHWAY 22
ROANOKE AL
36274-2410
US

IV. Provider business mailing address

PO BOX 670
ROANOKE AL
36274-0670
US

V. Phone/Fax

Practice location:
  • Phone: 334-863-4111
  • Fax: 334-863-5427
Mailing address:
  • Phone: 334-863-4111
  • Fax: 334-863-5427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH5601
License Number StateAL

VIII. Authorized Official

Name: MR. JON DIXON
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 334-863-4111