Provider Demographics
NPI:1093069569
Name:PICKENS COUNTY HEALTH CARE AUTHORITY
Entity Type:Organization
Organization Name:PICKENS COUNTY HEALTH CARE AUTHORITY
Other - Org Name:P C H C AUTHORITY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MCELROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-367-8111
Mailing Address - Street 1:241 ROBERT K WILSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:AL
Mailing Address - Zip Code:35447-0478
Mailing Address - Country:US
Mailing Address - Phone:205-367-8111
Mailing Address - Fax:205-367-2121
Practice Address - Street 1:241 ROBERT K WILSON DRIVE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:AL
Practice Address - Zip Code:35447-0478
Practice Address - Country:US
Practice Address - Phone:205-367-8111
Practice Address - Fax:205-367-2121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PICKENS COUNTY HEALTH CARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-05
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty