Provider Demographics
NPI:1659533206
Name:DALE MEDICAL CENTER
Entity Type:Organization
Organization Name:DALE MEDICAL CENTER
Other - Org Name:OLIVER W CRAWFORD JR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-774-2601
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36361-0863
Mailing Address - Country:US
Mailing Address - Phone:334-774-5864
Mailing Address - Fax:334-774-1437
Practice Address - Street 1:218 HOSPITAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-2064
Practice Address - Country:US
Practice Address - Phone:334-774-5864
Practice Address - Fax:334-774-1437
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DALE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-25
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty