Provider Demographics
NPI:1366427437
Name:THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI
Entity type:Organization
Organization Name:THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:334-383-2423
Mailing Address - Street 1:PO BOX 1547
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65302-1547
Mailing Address - Country:US
Mailing Address - Phone:660-826-5960
Mailing Address - Fax:660-826-4852
Practice Address - Street 1:29 L V STABLER DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3850
Practice Address - Country:US
Practice Address - Phone:334-382-2671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-13
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529901180Medicaid
ALCI7411OtherRR MEDICARE
ALCI7411OtherRR MEDICARE