Provider Demographics
NPI:1740496876
Name:DECATUR GENERAL HOSPITAL
Entity type:Organization
Organization Name:DECATUR GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-584-8093
Mailing Address - Street 1:1107 14TH AVE SE
Mailing Address - Street 2:SUITE G500 / G400
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3309
Mailing Address - Country:US
Mailing Address - Phone:256-584-8038
Mailing Address - Fax:256-584-8136
Practice Address - Street 1:1107 14TH AVE SE
Practice Address - Street 2:SUITE G500/G400
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3309
Practice Address - Country:US
Practice Address - Phone:256-584-8038
Practice Address - Fax:256-584-8136
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECATUR GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-15
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529926370Medicaid
ALF918OtherBCBS
ALF918OtherBCBS