Provider Demographics
NPI:1235285867
Name:CLAY COUNTY HEALTHCARE AUTHORITY
Entity Type:Organization
Organization Name:CLAY COUNTY HEALTHCARE AUTHORITY
Other - Org Name:CLAY COUNTY HOSPTIAL DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:TOMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-354-2131
Mailing Address - Street 1:PO BOX 1270
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36251-1270
Mailing Address - Country:US
Mailing Address - Phone:256-354-2509
Mailing Address - Fax:256-354-2825
Practice Address - Street 1:57 FLOYD SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:AL
Practice Address - Zip Code:36251-1270
Practice Address - Country:US
Practice Address - Phone:256-354-2509
Practice Address - Fax:256-354-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL076002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51056911OtherBCBS PROVIDER NUMBER
AL009814360Medicaid