Provider Demographics
NPI:1770647653
Name:TOMBIGBEE HEALTHCARE AUTHORITY
Entity Type:Organization
Organization Name:TOMBIGBEE HEALTHCARE AUTHORITY
Other - Org Name:GERI-PSYCH UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-287-2500
Mailing Address - Street 1:105 US HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-3605
Mailing Address - Country:US
Mailing Address - Phone:334-289-4000
Mailing Address - Fax:334-287-2594
Practice Address - Street 1:105 US HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3605
Practice Address - Country:US
Practice Address - Phone:334-289-4000
Practice Address - Fax:334-287-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01S112Medicare ID - Type UnspecifiedGERI-PSYCH