=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154386431
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE EAST ALABAMA HEALTH CARE AUTHORITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2006
-----------------------------------------------------
Last Update Date | 12/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 PEPPERELL PKWY
-----------------------------------------------------
City | OPELIKA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36801-5452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-528-1275
-----------------------------------------------------
Fax | 334-528-1547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 PEPPERELL PKWY
-----------------------------------------------------
City | OPELIKA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36801-5452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-528-1275
-----------------------------------------------------
Fax | 334-528-1547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. SAMUEL A PRICE JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 334-528-1310
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 10376
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------