Provider Demographics
NPI:1124356563
Name:HALE COUNTY HOSPITAL
Entity Type:Organization
Organization Name:HALE COUNTY HOSPITAL
Other - Org Name:HALE COUNTY PHYSICIAN GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:OGDEN
Authorized Official - Last Name:LACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-624-3024
Mailing Address - Street 1:508 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:36744-2316
Mailing Address - Country:US
Mailing Address - Phone:334-624-3024
Mailing Address - Fax:334-624-4453
Practice Address - Street 1:508 GREENE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-2316
Practice Address - Country:US
Practice Address - Phone:334-624-3024
Practice Address - Fax:334-624-4453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALE COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-23
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALH3301207P00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102G706409Medicare Oscar/Certification