Healthcare Provider Details

I. General information

NPI: 1679595540
Provider Name (Legal Business Name): HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8578 US HIGHWAY 80 W
TYLER AL
36785-5417
US

IV. Provider business mailing address

PO BOX 70355
MONTGOMERY AL
36107-0355
US

V. Phone/Fax

Practice location:
  • Phone: 334-872-1966
  • Fax: 334-872-0909
Mailing address:
  • Phone: 334-420-5038
  • Fax: 334-420-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01D0967311
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerCLIA
# 2
Identifier630004009
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer

VIII. Authorized Official

Name: GEORGE R WALDROP
Title or Position: CFO
Credential:
Phone: 334-420-5001