Provider Demographics
NPI:1558464511
Name:HALE COUNTY HOSPITAL
Entity Type:Organization
Organization Name:HALE COUNTY HOSPITAL
Other - Org Name:HALE COUNTY HOSPITAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:LACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-624-3024
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:36744
Mailing Address - Country:US
Mailing Address - Phone:334-624-4442
Mailing Address - Fax:334-624-1405
Practice Address - Street 1:508 GREENE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-2316
Practice Address - Country:US
Practice Address - Phone:334-624-4442
Practice Address - Fax:334-624-1405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALE COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-06
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529303070Medicaid
AL121780Medicaid
AL529303070Medicaid
AL013447Medicare Oscar/Certification