Provider Demographics
NPI:1093729832
Name:GADSDEN REGIONAL MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:GADSDEN REGIONAL MEDICAL CENTER LLC
Other - Org Name:GADSDEN REGIONAL HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BUSINESS OFFICE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:PO BOX 404799
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4799
Mailing Address - Country:US
Mailing Address - Phone:256-494-4585
Mailing Address - Fax:256-494-4474
Practice Address - Street 1:1601 W MEIGHAN BLVD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901
Practice Address - Country:US
Practice Address - Phone:256-546-6319
Practice Address - Fax:256-546-2295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GADSDEN REGIONAL MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1339332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00057922Medicaid
0616660001Medicare NSC