Provider Demographics
NPI:1194811901
Name:CRENSHAW COUNTY HEALTH CARE AUTHORITY
Entity type:Organization
Organization Name:CRENSHAW COUNTY HEALTH CARE AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KIMBRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-335-3374
Mailing Address - Street 1:101 HOSPITAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-7344
Mailing Address - Country:US
Mailing Address - Phone:334-335-3374
Mailing Address - Fax:334-335-1119
Practice Address - Street 1:58 ROY BEALL DR
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-6800
Practice Address - Country:US
Practice Address - Phone:334-335-1212
Practice Address - Fax:334-335-1217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRENSHAW COUNTY HEALTH CARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL540003411Medicaid
AL051518337OtherBC PROVIDER NUMBER
AL01-3411Medicare ID - Type UnspecifiedMEDICARE PROVIDER # UB92
ALJ020Medicare ID - Type UnspecifiedMEDICARE PROVIDER # 1500