Provider Demographics
NPI:1144270257
Name:GROVE HILL MEMORIAL HOSPITAL,INC
Entity type:Organization
Organization Name:GROVE HILL MEMORIAL HOSPITAL,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:H
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-275-3191
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:GROVE HILL
Mailing Address - State:AL
Mailing Address - Zip Code:36451-0935
Mailing Address - Country:US
Mailing Address - Phone:251-275-3191
Mailing Address - Fax:251-275-4281
Practice Address - Street 1:218 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:AL
Practice Address - Zip Code:36446-2000
Practice Address - Country:US
Practice Address - Phone:334-636-4823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL540003922Medicaid
AL01-3436Medicare ID - Type Unspecified