Provider Demographics
NPI:1851388557
Name:EASTERN HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:EASTERN HEALTH SYSTEMS INC
Other - Org Name:MEDICAL CENTER BLOUNT EMERGENCY DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-274-3001
Mailing Address - Street 1:PO BOX 11407 LOCKBOX 1066
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0001
Mailing Address - Country:US
Mailing Address - Phone:205-437-6098
Mailing Address - Fax:205-437-5998
Practice Address - Street 1:150 GILBREATH DR
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2827
Practice Address - Country:US
Practice Address - Phone:205-264-9098
Practice Address - Fax:205-437-5998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN HEALTH SYSTEMS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-29
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529919550Medicaid
ALF858OtherBCBS GROUP NUMBER
AL20477400OtherBLACK LUNG - DPT OF LABOR
AL020477400OtherDEPT OF LABOR (OWCP)
ALCH1298OtherRAILROAD MEDICARE GROUP
AL3901711OtherUNITED HEALTHCARE OF AL
AL529919550Medicaid