Provider Demographics
NPI:1659396307
Name:THE HEALTH CARE AUTHORITY OF THE TOWN OF WEDOWEE
Entity Type:Organization
Organization Name:THE HEALTH CARE AUTHORITY OF THE TOWN OF WEDOWEE
Other - Org Name:WEDOWEE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-357-2111
Mailing Address - Street 1:203 TALLAPOOSA ST
Mailing Address - Street 2:
Mailing Address - City:WADLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36276
Mailing Address - Country:US
Mailing Address - Phone:256-395-4157
Mailing Address - Fax:256-395-6055
Practice Address - Street 1:203 TALLAPOOSA ST
Practice Address - Street 2:
Practice Address - City:WADLEY
Practice Address - State:AL
Practice Address - Zip Code:36276
Practice Address - Country:US
Practice Address - Phone:256-395-4157
Practice Address - Fax:256-395-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL541003937Medicaid