Provider Demographics
NPI:1497852735
Name:D.W. MCMILLAN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:D.W. MCMILLAN MEMORIAL HOSPITAL
Other - Org Name:FLOMATON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-809-8429
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:FLOMATON
Mailing Address - State:AL
Mailing Address - Zip Code:36441-0997
Mailing Address - Country:US
Mailing Address - Phone:251-296-2456
Mailing Address - Fax:251-296-0320
Practice Address - Street 1:174 HIGHWAY 113
Practice Address - Street 2:
Practice Address - City:FLOMATON
Practice Address - State:AL
Practice Address - Zip Code:36441-0174
Practice Address - Country:US
Practice Address - Phone:251-296-2456
Practice Address - Fax:251-296-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11799261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL013440Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC