Provider Demographics
NPI:1639293392
Name:BLOUNTSVILLE HEALTH CENTER
Entity Type:Organization
Organization Name:BLOUNTSVILLE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-737-2882
Mailing Address - Street 1:PO BOX 13128
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-3128
Mailing Address - Country:US
Mailing Address - Phone:205-715-5904
Mailing Address - Fax:205-715-5928
Practice Address - Street 1:68278 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35031-3370
Practice Address - Country:US
Practice Address - Phone:205-429-4151
Practice Address - Fax:205-729-4604
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CULLMAN REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529907730Medicaid
AL529907730Medicaid