Provider Demographics
NPI:1396781209
Name:SIXFOURTHREE, LLC
Entity type:Organization
Organization Name:SIXFOURTHREE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-883-1970
Mailing Address - Street 1:PO BOX 18863
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-8863
Mailing Address - Country:US
Mailing Address - Phone:256-883-1970
Mailing Address - Fax:256-883-1336
Practice Address - Street 1:4240 BALMORAL DR SW STE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5633
Practice Address - Country:US
Practice Address - Phone:256-883-1970
Practice Address - Fax:256-883-8061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ163OtherMEDICARE GROUP ID
ALK587OtherMEDICARE GROUP ID