Organization
HOUSTON COUNTY HEALTHCARE AUTHORITY
Active
Parent organization
HOUSTON COUNTY HEALTHCARE AUTHORITY
Other names
SAMC- Profee Billing
Organization subpart
Yes
Provider details
NPI number
Legal business name
HOUSTON COUNTY HEALTHCARE AUTHORITY
Authorized official
REGINA G MAY CPC (CONTRACT MANAGER)
(334) 793-8087
Entity
Organization
Contact information
Practice address
1108 ROSS CLARK CIR, DOTHAN, AL 36301-3022
(334) 793-8087
(334) 793-8191
Mailing address
PO BOX 1928, DOTHAN, AL 36302-1928
(334) 793-8087
(334) 793-8191
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
2084N0400X
Neurology Physician
—
—
363A00000X
Physician Assistant
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
253447900
FL MCAID PROFEE/ER GROUP
FL
01
—
311235700
FL MCAID CRNA GROUP
FL
05
—
558200000
—
AL
01
—
C867
BCBS GROUP NUMBER
AL
Enumeration date
01/09/2007
Last updated
11/05/2007
Update your record
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