Provider Demographics
NPI:1467506469
Name:PICKENS COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:PICKENS COUNTY MEDICAL CENTER
Other - Org Name:PAUL D LAVENDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-367-8111
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:AL
Mailing Address - Zip Code:35447-0360
Mailing Address - Country:US
Mailing Address - Phone:205-364-7135
Mailing Address - Fax:205-364-2455
Practice Address - Street 1:27340 HWY 86
Practice Address - Street 2:
Practice Address - City:GORDO
Practice Address - State:AL
Practice Address - Zip Code:35466
Practice Address - Country:US
Practice Address - Phone:205-364-7135
Practice Address - Fax:205-364-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529922240Medicaid
AL051555132Medicare ID - Type UnspecifiedPROV NUMBER
AL529922240Medicaid