Basic Information
Provider Information | |||||||||
NPI: | 1477874337 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RCHP - FLORENCE LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NORTH ALABAMA MEDICAL CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1701 VETERANS DR | ||||||||
Address2: |   | ||||||||
City: | FLORENCE | ||||||||
State: | AL | ||||||||
PostalCode: | 356304928 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2567689191 | ||||||||
FaxNumber: | 2567689775 | ||||||||
Practice Location | |||||||||
Address1: | 1701 VETERANS DR | ||||||||
Address2: |   | ||||||||
City: | FLORENCE | ||||||||
State: | AL | ||||||||
PostalCode: | 356304928 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2566291000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/15/2010 | ||||||||
LastUpdateDate: | 04/26/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DILLON | ||||||||
AuthorizedOfficialFirstName: | TERRANCE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | ASSISTANT SECRETARY | ||||||||
AuthorizedOfficialTelephone: | 5025967220 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/26/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | H3902 | AL | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | 127071 | 05 | AL |   | MEDICAID | HOS0006H | 05 | AL |   | MEDICAID |