NPIMap

Organization Active NPI

Hale County Hospital

Doing business as Hale County Physician Group

  • Emergency Medicine Physician
  • Greensboro, AL
National Provider Identifier
1124356563
Registry record updated Jun 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
H3301 Issued in AL
Legal business name
HALE COUNTY HOSPITAL
Doing business as
Hale County Physician Group
Practice address
508 Greene St
Greensboro, AL 36744-2316
Phone
(334) 624-3024
Fax
(334) 624-4453
NPI assigned
Nov 23, 2009
Last updated
Jun 16, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
HALE COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2022

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

Authorized official

Name
Thomas Ogden Lackey
Title
Administrator
Phone
(334) 624-3024

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X H3301 AL Primary
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X H3301 AL

Addresses

Primary practice location

508 Greene St
Greensboro, AL 36744-2316

Mailing address

508 Greene St
Greensboro, AL 36744-2316
Phone (334) 624-3024

Other names 1

  • HALE COUNTY PHYSICIAN GROUP Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040624000445 AL Part B Supplier - Clinic/Group Practice 3375528169 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
Practice locations: Greensboro, AL

Other NPIs with the same Medicare PAC ID 5

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.

National Provider Directory

National Provider Directory
Part of
Greene Cnty Hospnurs H

Locations

508 Greene St
#2
Greensboro, AL 36744
Phone (334) 624-3024

40870 AL Highway 69
Ste A
Moundville, AL 35474
Phone (205) 371-4444

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1258934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655337600000",
    "number": "1124356563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 GREENE ST",
            "city": "GREENSBORO",
            "state": "AL",
            "postal_code": "367442316",
            "telephone_number": "334-624-3024",
            "fax_number": "334-624-4453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 GREENE ST",
            "city": "GREENSBORO",
            "state": "AL",
            "postal_code": "367442316",
            "telephone_number": "334-624-3024",
            "fax_number": "334-624-4453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALE COUNTY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HALE COUNTY HOSPITAL",
        "enumeration_date": "2009-11-23",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A",
        "authorized_official_last_name": "LACKEY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "OGDEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "334-624-3024"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "AL",
            "license": "H3301",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": "AL",
            "license": "H3301",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HALE COUNTY PHYSICIAN GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greensboro, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.