NPIMap

Organization Active NPI

Greene County Hospital & Nursing Home

  • Clinic/Center
  • Eutaw, AL
National Provider Identifier
1043389398
Registry record updated Feb 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GREENE COUNTY HOSPITAL & NURSING HOME
Practice address
607 Wilson Ave
Eutaw, AL 35462
Phone
(205) 372-4035
Fax
(205) 372-1228
NPI assigned
Nov 8, 2006
Organization subpart
Yes
Parent organization
GREENE COUNTY HOSPITAL & NURSING HOMEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Marcia Pugh
Title
Chief Executive Officer (Ceo)
Phone
(205) 994-8629

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

607 Wilson Ave
Eutaw, AL 35462

Mailing address

607 Wilson Ave
Eutaw, AL 35462
Phone (205) 372-4035

Other identifiers 2

IdentifierTypeStateIssuer
55890030MedicaidAL
010532OtherALBCBS

Other names 1

  • Greene County Hospital Physicians' Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040524000580 AL Part B Supplier - Clinic/Group Practice 7416948880 Receives reassigned benefits from 5 practitioners
Practice locations: Eutaw, AL
O20100720000320 AL Part A Provider - Rural Health Clinic 7416948880 Practice locations: Eutaw, AL

Rural health clinic certification: CCN 013449

Legal name
GREENE COUNTY HOSPITAL & NURSING HOME
Doing business as
GREENE COUNTY HOSPITAL PHYSICIANS' CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 27, 2010
Last certification
Nov 8, 2023
Ownership / control type
2A
Organization structure
OtherProprietary
Incorporated
Jan 1, 1990 in AL
Enrollment address
607 Wilson Ave
Eutaw, AL 35462-1136
Related CCNs
010051

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Greene County Hosp

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Marcia Pugh Individual Corporate Officer Dec 4, 2017
Corporate Director Dec 4, 2017
Cynthia Walker Individual Corporate Officer Apr 1, 2020
W-2 Managing Employee Apr 1, 2020

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Greene County Hospital & Nursing HomeEutaw, AL, CCN 010051 Hospital Operational/Managerial Control Oct 1, 2013
Greene County Health SystemEutaw, AL, CCN 015178 Skilled nursing facility Operational/Managerial Control Feb 8, 2010

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707955200000",
    "number": "1043389398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 WILSON AVE",
            "city": "EUTAW",
            "state": "AL",
            "postal_code": "35462",
            "telephone_number": "205-372-4035",
            "fax_number": "205-372-1228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 WILSON AVE",
            "city": "EUTAW",
            "state": "AL",
            "postal_code": "35462",
            "telephone_number": "205-372-4035",
            "fax_number": "205-372-1228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENE COUNTY HOSPITAL & NURSING HOME",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREENE COUNTY HOSPITAL  & NURSING HOME",
        "enumeration_date": "2006-11-08",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A",
        "authorized_official_last_name": "PUGH",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER (CEO)",
        "authorized_official_telephone_number": "205-994-8629",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55890030",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "010532",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greene County Hospital Physicians' Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Greene County Hospital Physicians' Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eutaw, AL

Sources for this page

Verify at the official NPI Registry.