Provider Demographics
NPI:1255959144
Name:FORT PAYNE HOSPITAL CORPORATION
Entity type:Organization
Organization Name:FORT PAYNE HOSPITAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3840
Mailing Address - Street 1:1573 MALLORY LN STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2895
Mailing Address - Country:US
Mailing Address - Phone:615-221-3758
Mailing Address - Fax:615-221-1456
Practice Address - Street 1:200 MEDICAL CENTER DR SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3458
Practice Address - Country:US
Practice Address - Phone:256-845-3150
Practice Address - Fax:256-997-2512
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORT PAYNE HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit