NPIMap

Organization Active NPI

Northeast Alabama Health Services, Inc.

Doing business as Northeast Alabama Health Services Inc- Skyline

  • Federally Qualified Health Center (FQHC)
  • Scottsboro, AL
National Provider Identifier
1093862237
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST ALABAMA HEALTH SERVICES, INC.
Doing business as
Northeast Alabama Health Services Inc- Skyline
Practice address
21680 Al Highway 79
Scottsboro, AL 35768-5904
Phone
(256) 587-3050
Fax
(256) 587-5243
NPI assigned
Jan 3, 2007
Last updated
May 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHEAST ALABAMA HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 28, 2024

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

Authorized official

Name
James P Allen Jr.
Title
Ceo
Phone
(256) 259-5313

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

21680 Al Highway 79
Scottsboro, AL 35768-5904

Mailing address

21680 Al Highway 79
Scottsboro, AL 35768-5904
Phone (256) 587-3050

Other identifiers 3

IdentifierTypeStateIssuer
F213OtherALSTATE MEDICARE
012222OtherALBLUE CROSS BLUE SHIELD
630007003MedicaidAL

Other names 1

  • NORTHEAST ALABAMA HEALTH SERVICES INC- SKYLINE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030910000046 AL Part A Provider - Federally Qualified Health Center (FQHC) 4082522883 1 other NPI on this enrollment
Practice locations: Scottsboro, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093862237. Details of each certification follow.

Federally qualified health center certification: CCN 011905

Legal name
NORTHEAST ALABAMA HEALTH SERVICES, INC.
Doing business as
SKYLINE PRIMARY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 12, 2000
Last certification
Jul 12, 2000
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 28, 1978 in AL
Enrollment address
21680 Alabama Highway 79
Scottsboro, AL 35768-5904

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0966034Northeast Alabama Health Services Inc - Skyline21680 Al Hwy 79, Scottsboro, AL 35768Certificate of waiverOct 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Sand MTN Primary HLT Ctr6 organizations share this tax ID, including this one
Part of
Sand MTN Primary HLT Ctr

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

21680 AL Highway 79
Scottsboro, AL 35768
Phone (256) 587-3050

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71711

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Jannette D Haley Individual Corporate Director Aug 23, 2022
Sylvia Nell Martin Individual Corporate Director Aug 1, 2010
Charles W Murphree Individual Corporate Director Aug 1, 2010
Leshia Wilhelm Individual Corporate OfficerCorporate Compliance Officer/DO Mar 10, 2021
W-2 Managing Employee Aug 1, 2010
Tiffany Graben Individual Corporate DirectorBoard Member Jul 28, 2020
Melissa Campbell Individual Corporate Director Aug 1, 2010
Keshia L Gardner Individual Corporate DirectorBoard Member Jan 26, 2016
Madel R Brown Individual Corporate DirectorBoard Member May 17, 2016
Amanda L Foshee Individual W-2 Managing EmployeeMD; Jun 2, 2023
Paul B Jones Individual Corporate DirectorBoard Member Mar 26, 2019
Angela R Saint Individual Corporate OfficerChief Financial Officer Jan 16, 2015
W-2 Managing Employee Aug 1, 2010
Gayla Bass Individual Corporate DirectorBoard Member Jun 1, 2014
James P Allen Individual W-2 Managing EmployeeChief Executive Officer Apr 29, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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.

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1093862237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21680 AL HIGHWAY 79",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "357685904",
            "telephone_number": "256-587-3050",
            "fax_number": "256-587-5243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21680 AL HIGHWAY 79",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "357685904",
            "telephone_number": "256-587-3050",
            "fax_number": "256-587-5243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ALABAMA HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST ALABAMA HEALTH SERVICES, INC.",
        "enumeration_date": "2007-01-03",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "256-259-5313",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICARE",
            "identifier": "F213",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "012222",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630007003",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHEAST ALABAMA HEALTH SERVICES INC- SKYLINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Scottsboro, AL

Sources for this page

Verify at the official NPI Registry.