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General NPI Number Information
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NPI Number | 1265516462
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Entity Type | Organization
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Legal Business Name | FAYETTE MEDICAL CENTER
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 04/22/2022
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Provider Practice Location Address
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Address Line | 1653 TEMPLE AVE N
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City | FAYETTE
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State | AL
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Zip | 35555-1314
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Country | US
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Telephone | 205-932-1280
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Fax | 205-759-6397
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Provider Business Mailing Address
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Address Line | 809 UNIVERSITY BLVD E
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City | TUSCALOOSA
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State | AL
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Zip | 35401-2029
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Country | US
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Telephone | 205-759-7378
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Fax | 205-759-6397
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS SERVICES
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Name | KERI H HINDMAN
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Credential |
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Telephone | 205-759-7378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 11804
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License Number State | AL
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