Healthcare Provider Details

I. General information

NPI: 1497041834
Provider Name (Legal Business Name): REGIONAL HEALTH MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 PRICE ST
ROANOKE AL
36274-2104
US

IV. Provider business mailing address

PO BOX 2345
ANNISTON AL
36202-2345
US

V. Phone/Fax

Practice location:
  • Phone: 334-863-2311
  • Fax: 334-863-5596
Mailing address:
  • Phone: 256-741-1198
  • Fax: 256-235-5608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1089488
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateAL

VIII. Authorized Official

Name: MR. JAMES LIPSCOMB
Title or Position: VP
Credential:
Phone: 256-741-1198