Provider Demographics
NPI:1417098054
Name:DECATUR GENERAL HOSPITAL
Entity Type:Organization
Organization Name:DECATUR GENERAL HOSPITAL
Other - Org Name:DECATUR CARDIOVASCULAR SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-341-2000
Mailing Address - Street 1:1101 SOMERVILLE RD SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3242
Mailing Address - Country:US
Mailing Address - Phone:256-350-4902
Mailing Address - Fax:256-350-4984
Practice Address - Street 1:1101 SOMERVILLE RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3242
Practice Address - Country:US
Practice Address - Phone:256-350-4902
Practice Address - Fax:256-350-4984
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECATUR GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-08
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC879OtherBCBS
ALC879OtherBCBS