Basic Information
Provider Information
NPI: 1114904968
EntityType: 2
ReplacementNPI:  
OrganizationName: THE HEALTH CARE AUTHORITY OF ELBA ALABAMA
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ELBA GENERAL HOSPITAL
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 987 DRAYTON AVE
Address2:  
City: ELBA
State: AL
PostalCode: 363231402
CountryCode: US
TelephoneNumber: 3348972257
FaxNumber: 3348971213
Practice Location
Address1: 987 DRAYTON AVE
Address2:  
City: ELBA
State: AL
PostalCode: 363231402
CountryCode: US
TelephoneNumber: 3348972257
FaxNumber: 3348971213
Other Information
ProviderEnumerationDate: 12/22/2005
LastUpdateDate: 04/05/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: NOLAND
AuthorizedOfficialFirstName: CHRIS
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CHIEF EXECUTIVE OFFICER
AuthorizedOfficialTelephone: 3348972257
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MHA, FACHE
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282NR1301X10328ALY HospitalsGeneral Acute Care HospitalRural

ID Information
IDTypeStateIssuerDescription
14301ALBLUE CROSS BLUE SHIELDOTHER
HOS0027H05AL MEDICAID


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