Provider Demographics
NPI:1043389398
Name:GREENE COUNTY HOSPITAL & NURSING HOME
Entity Type:Organization
Organization Name:GREENE COUNTY HOSPITAL & NURSING HOME
Other - Org Name:GREENE COUNTY HOSPITAL PHYSICIANS' CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER (CEO)
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-994-8629
Mailing Address - Street 1:607 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:EUTAW
Mailing Address - State:AL
Mailing Address - Zip Code:35462
Mailing Address - Country:US
Mailing Address - Phone:205-372-4035
Mailing Address - Fax:205-372-1228
Practice Address - Street 1:607 WILSON AVE
Practice Address - Street 2:
Practice Address - City:EUTAW
Practice Address - State:AL
Practice Address - Zip Code:35462
Practice Address - Country:US
Practice Address - Phone:205-372-4035
Practice Address - Fax:205-372-1228
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENE COUNTY HOSPITAL & NURSING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL55890030Medicaid
AL010532OtherBCBS