Basic Information
| Provider Information | |||||||||
| NPI: | 1720331481 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PICKENS COUNTY HEALTH CARE AUTHORITY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PICKENS COUNTY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 241 ROBERT K WILSON DR | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354470478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053678111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 241 ROBERT K WILSON DR | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354470478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053678111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2012 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MCBRYDE | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2053678111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | H5401 | AL | Y | Hospitals | General Acute Care Hospital |
No ID Information.