Provider Demographics
NPI:1568453389
Name:ATTENTUS MOULTON, LLC
Entity Type:Organization
Organization Name:ATTENTUS MOULTON, LLC
Other - Org Name:LAWRENCE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-974-2286
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-0039
Mailing Address - Country:US
Mailing Address - Phone:256-974-2200
Mailing Address - Fax:256-974-2299
Practice Address - Street 1:202 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1218
Practice Address - Country:US
Practice Address - Phone:256-974-2206
Practice Address - Fax:256-974-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11134282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALHOS0059HMedicaid
AL010102OtherBLUE CROSS OF ALABAMA
ALHOS0059HMedicaid
AL010059Medicare Oscar/Certification