Provider Demographics
NPI:1053321695
Name:ATHENS LIMESTONE HEALTH SERVICES
Entity Type:Organization
Organization Name:ATHENS LIMESTONE HEALTH SERVICES
Other - Org Name:ATHENS LIMESTONE HEALTH SERVICES PHYSICIAN GRUOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-233-9292
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35612-0999
Mailing Address - Country:US
Mailing Address - Phone:256-233-9292
Mailing Address - Fax:256-233-9272
Practice Address - Street 1:700 W MARKET ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2457
Practice Address - Country:US
Practice Address - Phone:256-233-9292
Practice Address - Fax:256-233-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025458208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty