NPIMap

Organization Active NPI

Whatley Health Services Inc

Doing business as LaBridgette R. Ellis Medical and Dental Center

  • Federally Qualified Health Center (FQHC)
  • Greensboro, AL
National Provider Identifier
1285655936
Registry record updated May 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WHATLEY HEALTH SERVICES INC
Doing business as
LaBridgette R. Ellis Medical and Dental Center
Practice address
800 Hall St
Greensboro, AL 36744
Phone
(334) 624-7270
Fax
(334) 624-0872
NPI assigned
Jul 21, 2006
Last updated
May 17, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
WHATLEY HEALTH SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 17, 2022

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

Authorized official

Name
David Gay Jr.
Title
Ceo
Phone
(205) 758-6647

Specialties & licenses 1

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

Addresses

Primary practice location

800 Hall St
Greensboro, AL 36744

Mailing address

2731 MLK Jr Blvd
Tuscaloosa, AL 35401-5235
Phone (205) 349-3250

Other identifiers 2

IdentifierTypeStateIssuer
630006005MedicaidAL
I747OtherALMEDICARE GROUP NUMBER

Other names 1

  • LaBridgette R. Ellis Medical and Dental Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101116000886 AL Part A Provider - Federally Qualified Health Center (FQHC) 8224921705 Practice locations: Greensboro, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285655936. Details of each certification follow.

Federally qualified health center certification: CCN 011936

Legal name
WHATLEY HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 20, 2004
Last certification
Aug 20, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 11, 1997 in AL
Enrollment address
800 Hall St
Greensboro, AL 36744-2517

Other NPIs with the same Medicare PAC ID 9

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

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
01D0992775Labridgette R Ellis Medical and Dental Center800 Hall Street, Greensboro, AL 36744Certificate of waiverOct 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Okaman Health Center16 organizations share this tax ID, including this one
Part of
Okaman Health Center

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Lena Hardaway Individual Corporate Director Sep 26, 2006
Jerry Palmer Individual Corporate Director Dec 16, 2014
Richard E Stroud Individual Corporate Officer Oct 29, 2016
W-2 Managing EmployeeManager Nov 1, 2016
Maxie Thomas Individual Corporate Director May 27, 1997
David Gay Individual Corporate OfficerChief Executive Officer Nov 1, 2018
W-2 Managing EmployeeChief Executive Officer Nov 1, 2018
Michael Hamilton Individual Corporate Director Sep 26, 2013
Audrey J Ellis Individual Corporate Director Dec 1, 2007
Cindy Deerman Individual Corporate Director Sep 10, 2013
James Morton Individual Corporate Director Jan 1, 2008
Charlotte Carter Individual Corporate Director Sep 25, 1997
Marcus Campbell Individual Corporate DirectorDirector Aug 1, 2015

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652745600000",
    "number": "1285655936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2731 MLK JR BLVD",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354015235",
            "telephone_number": "205-349-3250",
            "fax_number": "205-345-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 HALL ST",
            "city": "GREENSBORO",
            "state": "AL",
            "postal_code": "36744",
            "telephone_number": "334-624-7270",
            "fax_number": "334-624-0872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHATLEY HEALTH SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHATLEY HEALTH SERVICES, INC",
        "enumeration_date": "2006-07-21",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A",
        "authorized_official_last_name": "GAY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "205-758-6647",
        "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": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630006005",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "I747",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LaBridgette R. Ellis Medical and Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greensboro, AL

Sources for this page

Verify at the official NPI Registry.