Provider Demographics
NPI:1710749981
Name:MIZELL MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:MIZELL MEMORIAL HOSPITAL, INC
Other - Org Name:MIZELL STAT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-493-5790
Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1010
Mailing Address - Country:US
Mailing Address - Phone:334-493-5704
Mailing Address - Fax:
Practice Address - Street 1:702 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1626
Practice Address - Country:US
Practice Address - Phone:334-493-5704
Practice Address - Fax:334-493-9664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health