MEDICARE: D W MCMILLAN MEMORIAL HOSPITAL

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	261QR1300X	Rural Health Clinic/Center	17245	AL
2	261QP2300X	Primary Care Clinic/Center		AL

General Provider Information

NPI Number	:	1396125258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D W MCMILLAN MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 397
Second Line	:
City	:	CASTLEBERRY
State	:	AL
Zip	:	36432-0397
Country	:	US
Telephone Number	:	251-966-4600
Fax Number	:	251-966-7433

Provider Business Practice Location Address
First Line	:	1674 CLEVELAND AVE
Second Line	:
City	:	CASTLEBERRY
State	:	AL
Zip	:	36432
Country	:	US
Telephone Number	:	251-966-3400
Fax Number	:	251-966-7433

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHRIS GRIFFIN
Credential	:
Telephone Number	:	251-809-8398

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	07/15/2015

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