Provider Demographics
NPI:1629114590
Name:THE HEALTHCARE AUTHORITY OF ELBA ALABAMA
Entity Type:Organization
Organization Name:THE HEALTHCARE AUTHORITY OF ELBA ALABAMA
Other - Org Name:JOYCE P. GOETSCH, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, FACHE,
Authorized Official - Phone:334-897-2257
Mailing Address - Street 1:980 DRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:AL
Mailing Address - Zip Code:36323-1404
Mailing Address - Country:US
Mailing Address - Phone:334-897-3800
Mailing Address - Fax:334-897-3804
Practice Address - Street 1:980 DRAYTON AVE
Practice Address - Street 2:
Practice Address - City:ELBA
Practice Address - State:AL
Practice Address - Zip Code:36323-1404
Practice Address - Country:US
Practice Address - Phone:334-897-3800
Practice Address - Fax:334-897-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD 21731261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care