NPIMap

Organization Active NPI

Northeast Alabama Health Services, Inc.

Doing business as Northeast Alabama Health Services ,Inc. - Scottsboro

  • Federally Qualified Health Center (FQHC)
  • Scottsboro, AL
National Provider Identifier
1528115607
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST ALABAMA HEALTH SERVICES, INC.
Doing business as
Northeast Alabama Health Services ,Inc. - Scottsboro
Practice address
70 Freedom Drive
Scottsboro, AL 35769-3763
Phone
(256) 574-5508
Fax
(256) 259-2727
NPI assigned
Jan 4, 2007
Last updated
May 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHEAST ALABAMA HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 28, 2024

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

Authorized official

Name
James P Allen Jr.
Title
Ceo
Phone
(256) 259-5313

Specialties & licenses 1

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

Addresses

Primary practice location

70 Freedom Drive
Scottsboro, AL 35769-3763

Mailing address

70 Freedom Drive
Scottsboro, AL 35769-3763
Phone (256) 574-5508

Other identifiers 3

IdentifierTypeStateIssuer
630006003MedicaidAL
G926OtherALMEDICARE STATE
010970OtherALBLUE CROSS BLUE SHIELD

Other names 1

  • NORTHEAST ALABAMA HEALTH SERVICES ,INC. - SCOTTSBORO Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030910000048 AL Part A Provider - Federally Qualified Health Center (FQHC) 4082522883 Practice locations: Scottsboro, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1528115607. Details of each certification follow.

Federally qualified health center certification: CCN 011869

Legal name
NORTHEAST ALABAMA HEALTH SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 22, 1993
Last certification
Nov 22, 1993
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 28, 1978 in AL
Enrollment address
70 Freedom LN
Scottsboro, AL 35769-3763

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Jackson Co R HLT Sand MTN6 organizations share this tax ID, including this one
Part of
Jackson Co R HLT Sand MTN

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Jannette D Haley Individual Corporate DirectorBoard Member Aug 23, 2022
Sylvia Nell Martin Individual Corporate Director Aug 1, 2010
Charles W Murphree Individual Corporate Director Aug 1, 2010
Leshia Wilhelm Individual W-2 Managing Employee Aug 1, 2010
Tiffany Graben Individual Corporate DirectorBoard Member Jul 28, 2020
Melissa Campbell Individual Corporate Director Aug 1, 2010
Keshia L Gardner Individual Corporate DirectorBoard Member Jan 26, 2016
Madel R Brown Individual Corporate DirectorBoard Member May 17, 2016
Amanda L Foshee Individual W-2 Managing EmployeeMD; Jun 2, 2023
Paul B Jones Individual Corporate DirectorBoard Member Mar 26, 2019
Angela R Saint Individual W-2 Managing Employee Aug 1, 2010
Gayla Bass Individual Corporate Director Aug 1, 2010
James P Allen Individual W-2 Managing EmployeeChief Executive Officer Apr 29, 2024

Owners & managing parties with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1528115607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 FREEDOM DRIVE",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "357693763",
            "telephone_number": "256-574-5508",
            "fax_number": "256-259-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 FREEDOM DRIVE",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "357693763",
            "telephone_number": "256-574-5508",
            "fax_number": "256-259-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ALABAMA HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST ALABAMA HEALTH SERVICES, INC.",
        "enumeration_date": "2007-01-04",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "256-259-5313",
        "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": "630006003",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE STATE",
            "identifier": "G926",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "010970",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHEAST ALABAMA HEALTH SERVICES ,INC. - SCOTTSBORO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Scottsboro, AL

Sources for this page

Verify at the official NPI Registry.