MEDICARE: HOUSTON COUNTY HEALTHCARE AUTHORITY

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	10358	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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	010057	OTHER	AL	BLUE CROSS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164403861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON COUNTY HEALTHCARE AUTHORITY

Provider Business Mailing Address
First Line	:	PO BOX 6987
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36302-6987
Country	:	US
Telephone Number	:	334-793-8111
Fax Number	:	334-793-8779

Provider Business Practice Location Address
First Line	:	1108 ROSS CLARK CIRCLE
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36301-3022
Country	:	US
Telephone Number	:	334-793-8111
Fax Number	:	334-793-8779

Authorized Official
Title or Position	:	CFO
Name	:	ROBERT DEREK MILLER
Credential	:
Telephone Number	:	334-793-8701

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	10/25/2018

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Directions to “HOUSTON COUNTY HEALTHCARE AUTHORITY ” Practice Location

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