Basic Information
| Provider Information | |||||||||
| NPI: | 1558386359 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE HEALTH CARE AUTHORITY OF THE TOWN OF WEDOWEE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WEDOWEE HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 MAIN ST S | ||||||||
| Address2: | PO BOX 307 | ||||||||
| City: | WEDOWEE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362785139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563572111 | ||||||||
| FaxNumber: | 2563570175 | ||||||||
| Practice Location | |||||||||
| Address1: | 8427 HIGHWAY 431 | ||||||||
| Address2: | |||||||||
| City: | HEFLIN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362643940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562532031 | ||||||||
| FaxNumber: | 2562532058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 07/16/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DANIEL | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2563572111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.