NPIMap

Organization Active NPI

Houston County Healthcare Authority

  • Gynecology Physician
  • Dothan, AL
National Provider Identifier
1235469669
Registry record updated Jan 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
Legal business name
HOUSTON COUNTY HEALTHCARE AUTHORITY
Practice address
1118 Ross Clark Cir
Suite 210
Dothan, AL 36301-3001
Phone
(334) 702-6900
Fax
(334) 699-3169
NPI assigned
Jan 7, 2010
Organization subpart
Yes
Parent organization
HOUSTON COUNTY HEALTHCARE AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 7, 2010

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

Authorized official

Name
Mr. Robert Derek Miller
Title
Chief Financial Officer
Phone
(334) 793-8111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VG0400X Primary

Addresses

Primary practice location

1118 Ross Clark Cir
Suite 210
Dothan, AL 36301-3001

Mailing address

PO Box 1928
Dothan, AL 36302-1928
Phone (334) 793-8087

Other names 1

  • Living Well Medical Weight Loss & Aesthetics Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040219000209 AL Part B Supplier - Clinic/Group Practice 9436062296 Receives reassigned benefits from 540 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dothan, AL; Elba, AL; Enterprise, AL; Eufaula, AL; Midland City, AL; Taylor, AL; Troy, AL; Ashford, AL

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Part of
Houston County Hlthcare

NPI Registry JSON

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

{
    "created_epoch": "1262822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262822400000",
    "number": "1235469669",
    "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": "334-793-8087",
            "fax_number": "334-793-8191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 ROSS CLARK CIR",
            "address_2": "SUITE 210",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013001",
            "telephone_number": "334-702-6900",
            "fax_number": "334-699-3169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOUSTON COUNTY HEALTHCARE AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOUSTON COUNTY HEALTHCARE AUTHORITY",
        "enumeration_date": "2010-01-07",
        "last_updated": "2010-01-07",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "DEREK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "334-793-8111",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Living Well Medical Weight Loss & Aesthetics Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2010; 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.