MEDICARE: RUSSELL COUNTY COMMUNITY HOSPITAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital
2	282N00000X	General Acute Care Hospital	H5703	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023050101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSSELL COUNTY COMMUNITY HOSPITAL LLC

Provider Business Mailing Address
First Line	:	4401 RIVER CHASE DRIVE
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-7483
Country	:	US
Telephone Number	:	334-732-3000
Fax Number	:	334-732-3020

Provider Business Practice Location Address
First Line	:	4401 RIVER CHASE DR
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-7483
Country	:	US
Telephone Number	:	334-732-3000
Fax Number	:	334-732-3020

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MRS. RACHAEL H. CRENSHAW
Credential	:
Telephone Number	:	334-732-3010

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	04/04/2012

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