Provider Demographics
NPI:1235214768
Name:UNITED FLORALA INC.
Entity Type:Organization
Organization Name:UNITED FLORALA INC.
Other - Org Name:FLORALA MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:W
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-858-3287
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:24273 FIFTH AVENUE
Mailing Address - City:FLORALA
Mailing Address - State:AL
Mailing Address - Zip Code:36442-0189
Mailing Address - Country:US
Mailing Address - Phone:334-858-3287
Mailing Address - Fax:334-858-6814
Practice Address - Street 1:24273 FIFITH AVE
Practice Address - Street 2:
Practice Address - City:FLORALA
Practice Address - State:AL
Practice Address - Zip Code:36442-0189
Practice Address - Country:US
Practice Address - Phone:334-858-3287
Practice Address - Fax:334-858-6814
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED FLORALA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010201600Medicaid
AL010145OtherBCBS PROVIDER #
ALHOS0066HMedicaid
AL010066Medicare ID - Type UnspecifiedMEDICARE PROVIDER #