Provider Demographics
NPI:1063567329
Name:HOUSTON COUNTY HEALTHCARE AUTHORITY
Entity type:Organization
Organization Name:HOUSTON COUNTY HEALTHCARE AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:334-712-3311
Mailing Address - Street 1:PO BOX 1388
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-1388
Mailing Address - Country:US
Mailing Address - Phone:334-393-5010
Mailing Address - Fax:334-393-5013
Practice Address - Street 1:1109 BOLL WEEVILL CIRCLE
Practice Address - Street 2:SUITE 3
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2063
Practice Address - Country:US
Practice Address - Phone:334-393-5010
Practice Address - Fax:334-393-5013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSTON COUNTY HEALTHCARE AUTHORITY DBA SOUTHEAST AL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-24
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51543257OtherBCBS AL
AL0399130004Medicare NSC