Healthcare Authority of Elba, Al, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO314 Issued in AL

Legal business name

HEALTHCARE AUTHORITY OF ELBA, AL, INC.

Practice address

978 Drayton Ave
Elba, AL 36323-1404

Phone

(334) 897-2597

Fax

(334) 897-6662

NPI assigned

Jan 10, 2007

Organization subpart

No

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

Authorized official

Name

Ellen C. Briley, RN

Title

Chief Executive Officer

Phone

(334) 897-2257

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Glenn Roberts Doing business as

Locations

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831249283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "978 DRAYTON AVE",
            "city": "ELBA",
            "state": "AL",
            "postal_code": "363231404",
            "telephone_number": "334-897-2597",
            "fax_number": "334-897-6662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "978 DRAYTON AVE",
            "city": "ELBA",
            "state": "AL",
            "postal_code": "363231404",
            "telephone_number": "334-897-2597",
            "fax_number": "334-897-6662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHCARE AUTHORITY OF ELBA, AL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRILEY",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "334-897-2257",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "DO314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF AL",
            "identifier": "510-98808",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Glenn Roberts",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• First Choice Hospice, LLC
• Kelsee Breann Green, CRNP
• Healthcare Authority of Elba
• Healthcare Authority of Elba
• Healthcare Authority of Elba Inc
• Healthcare Authority of Elba, Al, Inc.
• Healthcare Authority of Elba, Inc.
• Alexandra Faith Horton
• Kate Hudson
• Timothy Michael Jackson, DMD

• All providers in Elba, AL
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.