Provider Demographics
NPI:1134530801
Name:ATTENTUS MOULTON LLC
Entity type:Organization
Organization Name:ATTENTUS MOULTON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER/BOARD MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-974-8839
Mailing Address - Street 1:202 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-1218
Mailing Address - Country:US
Mailing Address - Phone:256-974-2206
Mailing Address - Fax:256-974-2205
Practice Address - Street 1:202 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1218
Practice Address - Country:US
Practice Address - Phone:256-974-2206
Practice Address - Fax:256-974-2205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATTENTUS MOULTON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10583275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01-U059Medicare PIN