Provider Demographics
NPI:1619920741
Name:NURSING HOME PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:NURSING HOME PHYSICIAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-433-9801
Mailing Address - Street 1:ONE SOUTHERN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-1210
Mailing Address - Country:US
Mailing Address - Phone:251-433-9801
Mailing Address - Fax:251-432-3630
Practice Address - Street 1:950 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-2532
Practice Address - Country:US
Practice Address - Phone:251-433-9801
Practice Address - Fax:251-433-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000034778Medicare PIN