Provider Demographics
NPI:1164705380
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:
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 1:241 ROBERT K WILSON DR
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:205-367-2121
Practice Address - Street 1:241 ROBERT K WILSON DR
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:205-367-2121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PICKENS COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-23
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALH5401275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164423679OtherMEDICARE NPI
AL47910905Medicaid
1164423679OtherMEDICARE NPI