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Hale County Hospital

Organization Active NPI Rural Health Clinic/Center · Moundville, AL

NPI 1376901686 · NPPES record last updated Feb 1, 2016

Key facts

NPI
1376901686
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
HALE COUNTY HOSPITAL
Practice address
40870 Al Highway 69
Moundville, AL 35474-4366
Phone
(205) 371-4444
NPI assigned
Feb 1, 2016
Organization subpart
No

Authorized official

Name
Ms. Shay F Whaley
Title
Ceo
Phone
(334) 624-3024

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 5

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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 49

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

View all 49

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2110780Moundville Medical Associates
40870 Al Hwy 69 Ste a, Moundville, AL 35474		Certificate of waiverMar 22, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in AL

Rural health clinic certification: CCN 013468

Legal name
HALE COUNTY HOSPITAL
Doing business as
MOUNDVILLE MEDICAL ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 22, 2016
Last certification
May 10, 2023
Ownership / control type
2B
Organization structure
Government · Non-profit
Enrollment address
40870 Al Highway 69
Ste a
Moundville, AL 35474-4367
Related CCNs
010095

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
Jack Weeden
Individual 		Operational/Managerial Control
Director		 Oct 12, 2021
Dianne Bruner
Individual 		Corporate Officer
Chief Financial Officer		 Mar 5, 2024
W-2 Managing Employee
Chief Financial Officer		 Mar 5, 2024
Cynthia Renee Barnette
Individual 		Operational/Managerial Control
Director		 May 31, 2012
Bernard T Martin
Individual 		Operational/Managerial Control
Director		 Nov 27, 2012
Hale County Healthcare Authority
Organization · Greensboro, AL
Non-profit 		5% Or Greater Direct Ownership Interest Mar 1, 2016 100%
John a Dorsey
Individual 		Operational/Managerial Control
Director		 Oct 23, 2011
Lorrie P Cook
Individual 		Operational/Managerial Control
Director		 Feb 14, 2018
Meghan Bonds
Individual 		Operational/Managerial Control
Director		 Dec 2, 2021
Tiffany Lashay Fondren
Individual 		Corporate Officer
Chief Executive Officer		 Aug 4, 2014
W-2 Managing Employee Aug 4, 2014
Ethel Miller
Individual 		Operational/Managerial Control
Director		 Nov 17, 2022
Tony O Lee
Individual 		Operational/Managerial Control
Director		 Mar 17, 2009

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20160414001964 AL Part B Supplier - Clinic/Group Practice 3375528169 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
Practice locations: Moundville, AL
O20160706001293 AL Part a Provider - Rural Health Clinic 3375528169 Practice locations: Moundville, AL

National Provider Directory

Locations

1207 State St
#2
Greensboro, AL 36744
Phone (334) 624-3066

659 Tuscaloosa St
Greensboro, AL 36744
Phone (334) 624-3066

506 Greene St
Greensboro, AL 36744
Phone (334) 624-3066

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

40870 Al Highway 69
Moundville, AL 35474-4366

Mailing address

40870 Al Highway 69
Moundville, AL 35474-4366
Phone (205) 371-4444

Other names

  • Moundville Medical Associates Doing business as

Other providers in Moundville, AL

All providers in Moundville, AL · Rural Health Clinic/Center in Alabama

Sources for this page

Verify at the official NPI Registry.