Provider Demographics
NPI:1164423679
Name:PICKENS COUNTY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PICKENS COUNTY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:H
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:PO BOX 478
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:205-367-2408
Mailing Address - Fax:205-367-9123
Practice Address - Street 1:241 R 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:205-367-2408
Practice Address - Fax:205-367-9123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10402282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010129OtherBCBS
AL510C682OtherBLUE SHIELD
AL558200610Medicaid
ALHOS0109HMedicaid
ALC862Medicare PIN
ALG610Medicare PIN
AL010109Medicare Oscar/Certification