Provider Demographics
NPI:1609811538
Name:D. W. MCMILLAN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:D. W. MCMILLAN MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
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 1:1301 BELLEVILLE AVE
Mailing Address - Street 2:P. O. BOX 908
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-1306
Mailing Address - Country:US
Mailing Address - Phone:251-867-8061
Mailing Address - Fax:251-809-8137
Practice Address - Street 1:1301 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1306
Practice Address - Country:US
Practice Address - Phone:251-867-8061
Practice Address - Fax:251-809-8137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11799282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALHOS0099HMedicaid
AL010099Medicare ID - Type Unspecified