Whatley Health Services, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Vernon, AL
NPI 1114101383 · NPPES record last updated May 17, 2022
Key facts
- NPI
- 1114101383
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- WHATLEY HEALTH SERVICES, INC
- Practice address
- 230 Hospital Dr
Vernon, AL 35592-5251 - Phone
- (205) 695-0450
- Fax
- (205) 695-0451
- NPI assigned
- Dec 24, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- WHATLEY HEALTH SERVICES, INC
Authorized official
- Name
- Mr. David E Gay Jr.
- Title
- Ceo
- Phone
- (205) 758-6647
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 9
Practitioners 84
-
Geoffrey Nnamdi Alilonu, M.D.
-
Eva Marie Black, FNP-BC
-
Ramona Bonner, CRNP
-
Monica Mong Thuong Bui, D.O.
-
Jennifer L Burdette, M.D.
-
John E Burkhardt II, PSYD
-
Andreaus Deneice Croom, CRNP
-
Dana Gentry Eicher, CRNP
-
Tamer M Elsayed, MD
-
Jenna L Gaut, CRNP
-
Richard Giovane, M.D.
-
Haritha V Guttikonda, M.D.
-
Larissa Harkacz, M.D.
-
Joy Harris, CRNP
-
Aiesha S Hill, DPM
-
Niambi Ashaki Horton, DO, PHARM.D.
-
Jinwoo Hur, MD
-
Kyle S Johnson, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AL
Federally qualified health center certification: CCN 011948
- Legal name
- WHATLEY HEALTH SERVICES INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 14, 2008
- Last certification
- Mar 14, 2008
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 11, 1997 in AL
- Enrollment address
- 141 2ND Ave NW
Vernon, AL 35592-5765
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Jerry Palmer |
Corporate Director | Dec 16, 2014 | |
| Maxie Thomas |
Corporate Director | May 27, 1997 | |
| David Gay |
Corporate Officer |
Nov 1, 2018 | |
| W-2 Managing Employee |
Nov 1, 2018 | ||
| Audrey J Ellis |
Corporate Director | Dec 1, 2007 | |
| James Morton |
Corporate Director | Jan 1, 2008 | |
| Charlotte Carter |
Corporate Director | Mar 25, 1997 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040206000846 | AL | Part B Supplier - Clinic/Group Practice | 8224921705 |
Receives reassigned benefits from 230 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tuscaloosa, AL; Vernon, AL; Sipsey, AL; Livingston, AL; Greensboro, AL; Gordo, AL; Eutaw, AL; Carrollton, AL… |
| O20080204000172 | AL | Part a Provider - Federally Qualified Health Center (FQHC) | 8224921705 | Practice locations: Vernon, AL |
National Provider Directory
- Part of
- Whatley Health Services Inc
Locations
230 Hospital Dr
Vernon, AL 35592
Phone (205) 614-6060
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
230 Hospital Dr
Vernon, AL 35592-5251
Mailing address
2731 MLK Jr Blvd
Tuscaloosa, AL 35401-5235
Phone (205) 349-3250
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 630011005 | Medicaid | AL |
Other names
- VERNON HEALTH CENTER
Other providers in Vernon, AL
- Terena Stidham
- Twin States Home Healthcare, Inc.
- Two Doc, PLLC
- Vernon Medical Center
- Vernon Opco LLC
- Daniel Joe Whisenant
- Larry Joe Whisenant
All providers in Vernon, AL · Federally Qualified Health Center (FQHC) in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.