Provider Demographics
NPI:1013098300
Name:DEKALB COUNTY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:DEKALB COUNTY HOSPITAL ASSOCIATION
Other - Org Name:DEKALB AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-845-4027
Mailing Address - Street 1:PO BOX 680643
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-1607
Mailing Address - Country:US
Mailing Address - Phone:256-845-4027
Mailing Address - Fax:256-845-5860
Practice Address - Street 1:208 AIRPORT RD W
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3335
Practice Address - Country:US
Practice Address - Phone:256-845-4027
Practice Address - Fax:256-845-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL200025108Medicaid
AL200025108Medicaid