Basic Information
| Provider Information | |||||||||
| NPI: | 1073791372 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL ALABAMA MEDICAL ASSOCIATES, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHILTON MEDICAL CENTER HOME HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 LAY DAM ROAD | ||||||||
| Address2: | |||||||||
| City: | CLANTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350461920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052804663 | ||||||||
| FaxNumber: | 2052803489 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 LAY DAM RD | ||||||||
| Address2: | |||||||||
| City: | CLANTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350452306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052804663 | ||||||||
| FaxNumber: | 2052803489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2008 | ||||||||
| LastUpdateDate: | 01/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | J | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | HOME HEALTH ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2052804663 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SUNLINK | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 1284-HHA | AL | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 510-93666 | 01 | AL | B/C B/S | OTHER | CHI7107A | 05 | AL | MEDICAID |