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General NPI Number Information
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NPI Number | 1962056143
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Entity Type | Organization
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Legal Business Name | MIZELL MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 07/26/2019
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Last Update Date | 12/24/2019
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Provider Practice Location Address
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Address Line | 702 N MAIN ST
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City | OPP
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State | AL
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Zip | 36467-1626
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Country | US
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Telephone | 334-493-3541
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1010
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City | OPP
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State | AL
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Zip | 36467-1010
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Country | US
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Telephone | 334-493-3541
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JANA WYATT
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Credential |
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Telephone | 334-493-9111
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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 |
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License Number State |
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