Organization
MIZELL MEMORIAL HOSPITAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANA WYATT CPA (CHIEF EXECUTIVE OFFICER)
(334) 493-9111
Entity
Organization
Contact information
Practice address
702 N MAIN ST, OPP, AL 36467-1626
(334) 493-3541
(334) 493-9433
Mailing address
PO BOX 1010, OPP, AL 36467-1010
(334) 493-3541
(334) 493-3789
Taxonomy
Speciality
Code
Description
License number
State
261QL0400X
Lithotripsy Clinic/Center
—
—
273R00000X
Psychiatric Hospital Unit
—
AL
275N00000X
Medicare Defined Swing Bed Hospital Unit
—
AL
282NR1301X
Rural Acute Care Hospital
Primary
11789
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010095
BLUE CROSS BLUE SHIELD
AL
05
—
HOS0007H
—
AL
Enumeration date
07/19/2006
Last updated
12/24/2019
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