Provider Demographics
NPI:1629152822
Name:FAYETTE MEDICAL CENTER
Entity Type:Organization
Organization Name:FAYETTE MEDICAL CENTER
Other - Org Name:HOSPICE OF FAYETTE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCOUNTS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:HENLEY
Authorized Official - Last Name:HINDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-759-7378
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:1653 TEMPLE AVENUE NORTH
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-0710
Mailing Address - Country:US
Mailing Address - Phone:205-932-5966
Mailing Address - Fax:205-932-8054
Practice Address - Street 1:120 15TH STREET NW
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1526
Practice Address - Country:US
Practice Address - Phone:205-932-8057
Practice Address - Fax:205-932-8054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11656251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPIC1540EMedicaid
AL011549OtherBLUE CROSS
AL011540Medicare Oscar/Certification