Provider Demographics
NPI:1356498505
Name:NORTHEAST ALABAMA HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:NORTHEAST ALABAMA HEALTH SERVICES, INC.
Other - Org Name:NORTHEAST ALABAMA HEALTH SERVICES INC - NORTH SAND MOUNTAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:F
Authorized Official - Last Name:CULPEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-259-5313
Mailing Address - Street 1:29810 AL HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AL
Mailing Address - Zip Code:35958-5240
Mailing Address - Country:US
Mailing Address - Phone:256-597-4114
Mailing Address - Fax:256-597-4115
Practice Address - Street 1:29810 AL HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AL
Practice Address - Zip Code:35958-5240
Practice Address - Country:US
Practice Address - Phone:256-597-4114
Practice Address - Fax:256-597-4115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST ALABAMA HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-03
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL012401OtherBLUE CROSS BLUE SHIELD
AL630009003Medicaid
ALJ344OtherSTATE MEDICARE
ALJ344OtherSTATE MEDICARE
AL630009003Medicaid