Basic Information
| Provider Information | |||||||||
| NPI: | 1992793046 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PICKENS COUNTY MEDICAL CENTER, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | NEW DAY SENIOR CARE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 241 ROBERT K WILSON DR | ||||||||
| Address2: | P O BOX 478 | ||||||||
| City: | CARROLLTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354478010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053672100 | ||||||||
| FaxNumber: | 2053679123 | ||||||||
| Practice Location | |||||||||
| Address1: | 241 ROBERT K WILSON DR | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354478010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053672100 | ||||||||
| FaxNumber: | 2053679123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 03/24/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MCELROY | ||||||||
| AuthorizedOfficialFirstName: | H | ||||||||
| AuthorizedOfficialMiddleName: | WAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2053672100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 10402 | AL | Y | Hospital Units | Psychiatric Unit |
No ID Information.