NPIMap

Organization Active NPI

The Sylacauga Health Care Authority

Doing business as Coosa Valley Specialty Pharmacy

  • Community/Retail Pharmacy
  • Sylacauga, AL
National Provider Identifier
1689380800
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
THE SYLACAUGA HEALTH CARE AUTHORITY
Doing business as
Coosa Valley Specialty Pharmacy
Practice address
315 W Hickory St Ste 151
Sylacauga, AL 35150-2913
Phone
(256) 401-4690
Fax
(256) 401-4693
NPI assigned
Jan 31, 2023
Last updated
Jan 31, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
THE SYLACAUGA HEALTH CARE AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Authorized official

Name
Glenn Sisk
Title
Ceo
Phone
(256) 401-4602

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

315 W Hickory St Ste 151
Sylacauga, AL 35150-2913

Mailing address

315 W Hickory St Ste 151
Sylacauga, AL 35150-2913
Phone (256) 401-4690

Other names 1

  • Coosa Valley Specialty Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231218004216 AL DME Supplier - Pharmacy 5294710398 Practice locations: Sylacauga, AL

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Sylacauga Health Care Authority Inc10 organizations share this tax ID, including this one
Part of
Sylacauga Health Care Authority Inc

Other organizations with this tax ID 9

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

Locations

209 W Spring St
Ste 100
Sylacauga, AL 35150
Phone (256) 249-5888

315 W Hickory St
Ste 151
Sylacauga, AL 35150
Phone (256) 401-4690

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Coosa Valley HospiceSylacauga, AL, CCN 011661 Hospice 5% Or Greater Direct Ownership Interest Mar 8, 2007
Nix Family MedicineChildersburg, AL, CCN 018503 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2023
Jul 1, 2023

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 69

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 69

NPI Registry JSON

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

{
    "created_epoch": "1675123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1689380800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 W HICKORY ST STE 151",
            "city": "SYLACAUGA",
            "state": "AL",
            "postal_code": "351502913",
            "telephone_number": "256-401-4690",
            "fax_number": "256-401-4693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W HICKORY ST STE 151",
            "city": "SYLACAUGA",
            "state": "AL",
            "postal_code": "351502913",
            "telephone_number": "256-401-4690",
            "fax_number": "256-401-4693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SYLACAUGA HEALTH CARE AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE SYLACAUGA HEALTH CARE AUTHORITY",
        "enumeration_date": "2023-01-31",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-24",
        "status": "A",
        "authorized_official_last_name": "SISK",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "256-401-4602"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coosa Valley Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sylacauga, AL

Sources for this page

Verify at the official NPI Registry.