Provider Demographics
NPI:1457418659
Name:NORTHEAST ALABAMA HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:NORTHEAST ALABAMA HEALTH SERVICES, INC.
Other - Org Name:NORTHEAST ALABAMA HEALTH SERVICES INC - SECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:256-259-5313
Mailing Address - Street 1:60 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:SECTION
Mailing Address - State:AL
Mailing Address - Zip Code:35771-7168
Mailing Address - Country:US
Mailing Address - Phone:256-228-3471
Mailing Address - Fax:256-228-7289
Practice Address - Street 1:60 MAIN ST N
Practice Address - Street 2:
Practice Address - City:SECTION
Practice Address - State:AL
Practice Address - Zip Code:35771-7168
Practice Address - Country:US
Practice Address - Phone:256-228-3471
Practice Address - Fax:256-228-7289
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST ALABAMA HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-03
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010969OtherBLUE CROSS BLUE SHIELD
AL630002003Medicaid
ALD515OtherSTATE MEDICARE
AL010969OtherBLUE CROSS BLUE SHIELD
AL630002003Medicaid