Provider Demographics
NPI:1760420541
Name:THE HEALTHCARE AUTHORITY OF LAUDERDALE COUNTY AND THE CITY OF FLORENCE
Entity Type:Organization
Organization Name:THE HEALTHCARE AUTHORITY OF LAUDERDALE COUNTY AND THE CITY OF FLORENCE
Other - Org Name:ELIZA COFFEE MEMORIAL HOSPITAL - ER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MYNCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-768-9510
Mailing Address - Street 1:PO BOX 10005
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-2005
Mailing Address - Country:US
Mailing Address - Phone:866-313-5265
Mailing Address - Fax:205-313-5245
Practice Address - Street 1:205 MARENGO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6033
Practice Address - Country:US
Practice Address - Phone:866-313-5265
Practice Address - Fax:205-313-5245
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEATHCARE AUTHORITY OF LAUDERDALE COUNTY AND THE CITY OF FLORENCE,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-03
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCG4578OtherRR MCARE GRP #
AL558200140Medicaid
ALC896Medicare ID - Type Unspecified