=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861638074
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GADSDEN REGIONAL OCCUPATIONAL HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2008
-----------------------------------------------------
Last Update Date | 12/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1007 GOODYEAR AVE
-----------------------------------------------------
City | GADSDEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35903-1195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-494-4500
-----------------------------------------------------
Fax | 256-494-4560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1007 GOODYEAR AVE
-----------------------------------------------------
City | GADSDEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35903-1195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-494-4500
-----------------------------------------------------
Fax | 256-494-4560
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DEPARTMENT DIRECTOR
-----------------------------------------------------
Name | MS. MARGUARETTA SINGLETON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-494-4500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Clinic/Center
-----------------------------------------------------
License Number | 1-096651
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------