Provider Demographics
NPI:1245226430
Name:FAYETTE MEDICAL CENTER
Entity Type:Organization
Organization Name:FAYETTE MEDICAL CENTER
Other - Org Name:FAYETTE MEDICAL CENTER LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCOUNTS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:H
Authorized Official - Last Name:HINDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-759-7378
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-0710
Mailing Address - Country:US
Mailing Address - Phone:205-932-1112
Mailing Address - Fax:205-932-1257
Practice Address - Street 1:1653 TEMPLE AVE N
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1314
Practice Address - Country:US
Practice Address - Phone:205-343-8500
Practice Address - Fax:205-932-1257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12539311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010124OtherBLUE CROSS
AL4753120SMedicaid
ALCG6924OtherRAILROAD MEDICARE
AL015154Medicare Oscar/Certification