NPIMap

Organization Active NPI

Houston County Healthcare Authority

Doing business as Southeast Reference Services

  • Clinical Medical Laboratory
  • Dothan, AL
National Provider Identifier
1114161601
Registry record updated Jul 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
200812031750 Issued in AL
Legal business name
HOUSTON COUNTY HEALTHCARE AUTHORITY
Doing business as
Southeast Reference Services
Practice address
1108 Ross Clark Cir
Dothan, AL 36301-3022
Phone
(334) 793-8048
Fax
(334) 712-3122
NPI assigned
Apr 28, 2009
Last updated
Jul 20, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
HOUSTON COUNTY HEALTHCARE AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 20, 2012

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

Authorized official

Name
Deborah S. Woodham, CPC
Title
Contract Manager
Phone
(334) 793-8087

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 200812031750 AL Primary

Addresses

Primary practice location

1108 Ross Clark Cir
Dothan, AL 36301-3022

Mailing address

PO Box 1928
Dothan, AL 36302-1928
Phone (334) 793-8048

Other names 1

  • Southeast Reference Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090724000431 AL Part B Supplier - Independent Clinical Laboratory 9436062296 Receives reassigned benefits from 1 practitioner
Practice locations: Dothan, AL

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
Tax ID family
Houston Cogeneva Med GRP17 organizations share this tax ID, including this one
Part of
Houston Cogeneva Med GRP

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Southeast Alabama HomecareDothan, AL, CCN 017024 Home health agency 5% Or Greater Direct Ownership Interest (33%) Dec 30, 2008
Southeast Alabama HomecareEnterprise, AL, CCN 017016 Home health agency 5% Or Greater Direct Ownership Interest (33%) Dec 30, 2008
Troy Regional Medical Center Home HealthTroy, AL, CCN 017096 Home health agency 5% Or Greater Indirect Ownership Interest (33%) Nov 1, 2014

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 88

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 88

NPI Registry JSON

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

{
    "created_epoch": "1240876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342742400000",
    "number": "1114161601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1928",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363021928",
            "telephone_number": "334-793-8048",
            "fax_number": "334-712-3122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 ROSS CLARK CIR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013022",
            "telephone_number": "334-793-8048",
            "fax_number": "334-712-3122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOUSTON COUNTY HEALTHCARE AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOUSTON COUNTY HEALTHCARE AUTHORITY",
        "enumeration_date": "2009-04-28",
        "last_updated": "2012-07-20",
        "status": "A",
        "authorized_official_last_name": "WOODHAM",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CONTRACT MANAGER",
        "authorized_official_telephone_number": "334-793-8087",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AL",
            "license": "200812031750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Reference Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.