Provider Demographics
NPI:1033309125
Name:DW MCMILLAN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DW MCMILLAN MEMORIAL HOSPITAL
Other - Org Name:CRNA DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-809-8429
Mailing Address - Street 1:1301 BELLEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-1306
Mailing Address - Country:US
Mailing Address - Phone:251-809-8410
Mailing Address - Fax:251-809-8137
Practice Address - Street 1:1301 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1306
Practice Address - Country:US
Practice Address - Phone:251-809-8410
Practice Address - Fax:251-809-8137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:D.W. MCMILLAN MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-26
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-079166367500000X
AL1-079087367500000X
AL1-046537367500000X
AL1-049331367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty