Basic Information
| Provider Information | |||||||||
| NPI: | 1548350473 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHPORT MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTHPORT MEDICAL CENTER - PSYCH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 UNIVERSITY BLVD E | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354012029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057597190 | ||||||||
| FaxNumber: | 2057596397 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | NORTHPORT | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354763360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053438500 | ||||||||
| FaxNumber: | 2057596397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HINDMAN | ||||||||
| AuthorizedOfficialFirstName: | KERI | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PATIENT ACCOUNTS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2057597378 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 11874 | AL | Y | Hospital Units | Psychiatric Unit |
No ID Information.