Provider Demographics
NPI:1831249283
Name:HEALTHCARE AUTHORITY OF ELBA, AL, INC.
Entity type:Organization
Organization Name:HEALTHCARE AUTHORITY OF ELBA, AL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:334-897-2257
Mailing Address - Street 1:978 DRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:AL
Mailing Address - Zip Code:36323-1404
Mailing Address - Country:US
Mailing Address - Phone:334-897-2597
Mailing Address - Fax:334-897-6662
Practice Address - Street 1:978 DRAYTON AVE
Practice Address - Street 2:
Practice Address - City:ELBA
Practice Address - State:AL
Practice Address - Zip Code:36323-1404
Practice Address - Country:US
Practice Address - Phone:334-897-2597
Practice Address - Fax:334-897-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-98808OtherBCBS OF AL
ALC32481Medicare UPIN