NPIMap

Organization Active NPI

The Health Care Authority of the City of Greenville - LV Stabler Hospi

  • Certified Registered Nurse Anesthetist
  • Greenville, AL
National Provider Identifier
1366427437
Registry record updated Feb 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI
Practice address
29 L V Stabler Dr
Greenville, AL 36037-3850
Phone
(334) 382-2671
NPI assigned
Dec 13, 2005
Organization subpart
Yes
Parent organization
THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 26, 2018

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

Authorized official

Name
David Glenn Wilcox, CPA
Title
Cfo
Phone
(334) 383-2423

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

29 L V Stabler Dr
Greenville, AL 36037-3850

Mailing address

PO Box 1547
Sedalia, MO 65302-1547
Phone (660) 826-5960

Other identifiers 2

IdentifierTypeStateIssuer
529901180MedicaidAL
CI7411OtherALRR MEDICARE

Other names 1

  • LV Stabler Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190102000211 AL Part B Supplier - Clinic/Group Practice 9436418209 Receives reassigned benefits from 5 practitioners
Practice locations: Greenville, AL

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Ivy Creek of Butler LLC7 organizations share this tax ID, including this one
Part of
Ivy Creek of Butler LLC

Other organizations with this tax ID 6

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

Ownership & related parties

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Regional Medical Center of Central AlabamaGreenville, AL, CCN 010150 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2017
Regional Medical Center of Central AlabamaGreenville, AL, CCN 01U150 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2017
Regional Medical Center of Central AlabamaGreenville, AL, CCN 01S150 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2017
Regional Medical Center ClinicsGreenville, AL, CCN 013457 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2019

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519603200000",
    "number": "1366427437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1547",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653021547",
            "telephone_number": "660-826-5960",
            "fax_number": "660-826-4852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 L V STABLER DR",
            "city": "GREENVILLE",
            "state": "AL",
            "postal_code": "360373850",
            "telephone_number": "334-382-2671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI",
        "enumeration_date": "2005-12-13",
        "last_updated": "2018-02-26",
        "status": "A",
        "authorized_official_last_name": "WILCOX",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "334-383-2423",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529901180",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CI7411",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LV Stabler Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LV Stabler Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, AL

Sources for this page

Verify at the official NPI Registry.