NPIMap

Organization Active NPI

Hale County Hospital

Doing business as Moundville Medical Associates

  • Rural Health Clinic/Center
  • Moundville, AL
National Provider Identifier
1376901686
Registry record updated Feb 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HALE COUNTY HOSPITAL
Doing business as
Moundville Medical Associates
Practice address
40870 Al Highway 69
Moundville, AL 35474-4366
Phone
(205) 371-4444
NPI assigned
Feb 1, 2016
Last updated
Feb 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2016

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

Authorized official

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

Specialties & licenses 1

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

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 1

  • Moundville Medical Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376901686. Details of each certification follow.

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
GovernmentNon-profit
Enrollment address
40870 Al Highway 69
Ste a
Moundville, AL 35474-4367
Related CCNs
010095

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

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.

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
01D2110780Moundville Medical Associates40870 Al Hwy 69 Ste a, Moundville, AL 35474Certificate of waiverMar 22, 2028

National Provider Directory

National Provider Directory

Locations

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

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

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

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

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

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
Jack Weeden Individual Operational/Managerial ControlDirector Oct 12, 2021
Dianne Bruner Individual Corporate OfficerChief Financial Officer Mar 5, 2024
W-2 Managing EmployeeChief Financial Officer Mar 5, 2024
Cynthia Renee Barnette Individual Operational/Managerial ControlDirector May 31, 2012
Bernard T Martin Individual Operational/Managerial ControlDirector 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 ControlDirector Oct 23, 2011
Lorrie P Cook Individual Operational/Managerial ControlDirector Feb 14, 2018
Meghan Bonds Individual Operational/Managerial ControlDirector Dec 2, 2021
Tiffany Lashay Fondren Individual Corporate OfficerChief Executive Officer Aug 4, 2014
W-2 Managing Employee Aug 4, 2014
Ethel Miller Individual Operational/Managerial ControlDirector Nov 17, 2022
Tony O Lee Individual Operational/Managerial ControlDirector Mar 17, 2009

Owners & managing parties with NPI records 2

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 46

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 46

NPI Registry JSON

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

{
    "created_epoch": "1454284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454284800000",
    "number": "1376901686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40870 AL HIGHWAY 69",
            "city": "MOUNDVILLE",
            "state": "AL",
            "postal_code": "354744366",
            "telephone_number": "205-371-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40870 AL HIGHWAY 69",
            "city": "MOUNDVILLE",
            "state": "AL",
            "postal_code": "354744366",
            "telephone_number": "205-371-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALE COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-01",
        "last_updated": "2016-02-01",
        "status": "A",
        "authorized_official_last_name": "WHALEY",
        "authorized_official_first_name": "SHAY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-624-3024",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moundville Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moundville, AL

Sources for this page

Verify at the official NPI Registry.