Provider Demographics
NPI:1992793046
Name:PICKENS COUNTY MEDICAL CENTER, INC
Entity type:Organization
Organization Name:PICKENS COUNTY MEDICAL CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:H
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MCELROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-367-2100
Mailing Address - Street 1:241 ROBERT K WILSON DR
Mailing Address - Street 2:P O BOX 478
Mailing Address - City:CARROLLTON
Mailing Address - State:AL
Mailing Address - Zip Code:35447-8010
Mailing Address - Country:US
Mailing Address - Phone:205-367-2100
Mailing Address - Fax:205-367-9123
Practice Address - Street 1:241 ROBERT K WILSON DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:AL
Practice Address - Zip Code:35447-8010
Practice Address - Country:US
Practice Address - Phone:205-367-2100
Practice Address - Fax:205-367-9123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10402273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01S109Medicare Oscar/Certification