=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881121556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GULF HEALTH HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2017
-----------------------------------------------------
Last Update Date | 05/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2002 MEDICAL CENTER DR
-----------------------------------------------------
City | BAY MINETTE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36507-4163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-435-1330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2002 MEDICAL CENTER DR
-----------------------------------------------------
City | BAY MINETTE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-435-1330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PATIENT ACCOUNT REP
-----------------------------------------------------
Name | MISS KERSANDRA RENA SMALL
-----------------------------------------------------
Credential | MEDICAL BILLER
-----------------------------------------------------
Telephone | 251-435-1330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------