NPIMap

Organization Active NPI

Whatley Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Eutaw, AL
National Provider Identifier
1831133958
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WHATLEY HEALTH SERVICES INC
Practice address
200 Morrow Ave
Eutaw, AL 35462-1106
Phone
(205) 372-0011
Fax
(205) 372-9079
NPI assigned
Jun 16, 2006
Last updated
Jun 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Authorized official

Name
Mr. David Gay Jr.
Title
Ceo
Phone
(205) 758-6647

Specialties & licenses 1

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

Addresses

Primary practice location

200 Morrow Ave
Eutaw, AL 35462-1106

Mailing address

PO Box 2400
Tuscaloosa, AL 35403-2400
Phone (205) 758-6647

Other identifiers 1

IdentifierTypeStateIssuer
630004005MedicaidAL

Other names 1

  • EUTAW HEALTH CENTER Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040809000547 AL Part A Provider - Federally Qualified Health Center (FQHC) 8224921705 Practice locations: Eutaw, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831133958. Details of each certification follow.

Federally qualified health center certification: CCN 011938

Legal name
WHATLEY HEALTH SERVICES INC
Doing business as
EUTAW HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 20, 2004
Last certification
Aug 20, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 11, 1997 in AL
Enrollment address
200 Morrow Ave
Eutaw, AL 35462-1106

Other NPIs with the same Medicare PAC ID 9

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

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
01D0990540Whatley Health Services/Eutaw200 Morrow Avenue, Eutaw, AL 35462Certificate of waiverAug 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Okaman Health Center16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Lena Hardaway Individual Corporate Director Sep 26, 2006
Jerry Palmer Individual Corporate Director Dec 16, 2014
Maxie Thomas Individual Corporate Director May 27, 1997
David Gay Individual Corporate OfficerChief Executive Officer Nov 1, 2018
W-2 Managing EmployeeChief Executive Officer Nov 1, 2018
Michael Hamilton Individual Corporate Director Sep 26, 2013
Audrey J Ellis Individual Corporate Director Dec 1, 2007
Cindy Deerman Individual Corporate Director Sep 26, 2013
James Morton Individual Corporate Director Jan 1, 2008
Charlotte Carter Individual Corporate Director Mar 25, 1997
Marcus Campbell Individual Corporate Director Aug 1, 2015

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1831133958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2400",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354032400",
            "telephone_number": "205-758-6647",
            "fax_number": "205-345-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MORROW AVE",
            "city": "EUTAW",
            "state": "AL",
            "postal_code": "354621106",
            "telephone_number": "205-372-0011",
            "fax_number": "205-372-9079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHATLEY HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "GAY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "205-758-6647",
        "authorized_official_name_prefix": "Mr.",
        "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": "630004005",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EUTAW HEALTH CENTER",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "EUTAW HEALTH CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Eutaw, AL

Sources for this page

Verify at the official NPI Registry.