Provider Demographics
NPI:1437330438
Name:WASHINGTON COUNTY HEALTHCARE AUTHORITY, INC
Entity Type:Organization
Organization Name:WASHINGTON COUNTY HEALTHCARE AUTHORITY, INC
Other - Org Name:WASHINGTON COUNTY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:W
Authorized Official - Last Name:OVERSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-847-2223
Mailing Address - Street 1:PO BOX 1358
Mailing Address - Street 2:
Mailing Address - City:CHATOM
Mailing Address - State:AL
Mailing Address - Zip Code:36518-1358
Mailing Address - Country:US
Mailing Address - Phone:251-847-2223
Mailing Address - Fax:251-847-3808
Practice Address - Street 1:14634 ST STEPHENS AVE
Practice Address - Street 2:
Practice Address - City:CHATOM
Practice Address - State:AL
Practice Address - Zip Code:36518
Practice Address - Country:US
Practice Address - Phone:251-847-2223
Practice Address - Fax:251-847-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529912700Medicaid
AL529202310Medicaid
AL529912700Medicaid