Provider Demographics
NPI:1851323836
Name:FAYETTE MEDICAL CENTER
Entity Type:Organization
Organization Name:FAYETTE MEDICAL CENTER
Other - Org Name:FAYETTE COUNTY HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PATIENT ACCCOUNTS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:H
Authorized Official - Last Name:HINDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-759-7378
Mailing Address - Street 1:809 UNIVERSITY BLVD E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2029
Mailing Address - Country:US
Mailing Address - Phone:205-759-7190
Mailing Address - Fax:205-750-5648
Practice Address - Street 1:1653 TEMPLE AVE N
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555
Practice Address - Country:US
Practice Address - Phone:205-932-5966
Practice Address - Fax:205-932-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
ALH2901282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010124OtherBLUE CROSS
AL558200720Medicaid
AL510C858OtherBLUE SHIELD
AL9195OtherHEALTHSPRINGS
ALA3555501OtherUNITED HEALTHCARE
ALC858OtherBLUE SHIELD MED B
ALHOS0045HMedicaid
AL510C858OtherBLUE SHIELD