Provider Demographics
NPI:1619963584
Name:PICKENS COUNTY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:PICKENS COUNTY MEDICAL CENTER, INC.
Other - Org Name:MEDICAL CENTER HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:H.
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MCELROY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:205-367-8111
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:241 ROBERT K. WILSON DRIVE
Mailing Address - City:CARROLLTON
Mailing Address - State:AL
Mailing Address - Zip Code:35447-0147
Mailing Address - Country:US
Mailing Address - Phone:205-367-8111
Mailing Address - Fax:
Practice Address - Street 1:241 ROBERT K WILSON DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:AL
Practice Address - Zip Code:35447-8010
Practice Address - Country:US
Practice Address - Phone:205-367-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PICKENS COUNTY MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-26
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALMED7092AMedicaid
ALMED7092AMedicaid