Provider Demographics
NPI:1649828328
Name:SIXFOURTHREE, LLC
Entity type:Organization
Organization Name:SIXFOURTHREE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:TODD
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:
Practice Address - Street 1:8490 HIGHWAY 72 W STE 120
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9575
Practice Address - Country:US
Practice Address - Phone:256-883-1970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization