Provider Demographics
NPI:1902120413
Name:NOLAND HOSPITAL SHELBY, LLC
Entity Type:Organization
Organization Name:NOLAND HOSPITAL SHELBY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-783-8460
Mailing Address - Street 1:600 CORPORATE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5450
Mailing Address - Country:US
Mailing Address - Phone:205-783-8440
Mailing Address - Fax:205-783-8441
Practice Address - Street 1:1000 1ST ST N
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8703
Practice Address - Country:US
Practice Address - Phone:205-620-8641
Practice Address - Fax:205-620-8692
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOLAND HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-26
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010170Medicare Oscar/Certification