Provider Demographics
NPI:1144469438
Name:HOUSTON COUNTY HEALTHCARE AUTHORITY
Entity type:Organization
Organization Name:HOUSTON COUNTY HEALTHCARE AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-793-8087
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-0578
Mailing Address - Country:US
Mailing Address - Phone:334-793-8087
Mailing Address - Fax:334-793-8191
Practice Address - Street 1:1806 FAIRVIEW AVE STE A
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3026
Practice Address - Country:US
Practice Address - Phone:334-793-8087
Practice Address - Fax:334-793-8191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSTON COUNTY HEALTHCARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-022372363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty