Provider Demographics
NPI:1659387082
Name:CLANTON HOSPITAL LLC
Entity Type:Organization
Organization Name:CLANTON HOSPITAL LLC
Other - Org Name:CHILTON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLLOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-755-2500
Mailing Address - Street 1:PO BOX 2220
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35046-2220
Mailing Address - Country:US
Mailing Address - Phone:205-755-2500
Mailing Address - Fax:205-280-3569
Practice Address - Street 1:1010 LAY DAM RD
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2306
Practice Address - Country:US
Practice Address - Phone:205-755-2500
Practice Address - Fax:205-280-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11777282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010118OtherBCBS PROVIDER #
ALHOS0043HMedicaid
AL010118OtherBCBS PROVIDER #