Provider Demographics
NPI:1467462283
Name:THE EAST ALABAMA HEALTHCARE AUTHORITY
Entity Type:Organization
Organization Name:THE EAST ALABAMA HEALTHCARE AUTHORITY
Other - Org Name:HOMEMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:334-528-1305
Mailing Address - Street 1:17 MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3665
Mailing Address - Country:US
Mailing Address - Phone:334-756-0701
Mailing Address - Fax:334-756-0703
Practice Address - Street 1:17 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3665
Practice Address - Country:US
Practice Address - Phone:334-756-0701
Practice Address - Fax:334-756-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL696332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1148230001Medicare ID - Type Unspecified
AL1148230002Medicare ID - Type Unspecified