NPIMap

Organization Active NPI

Healthcare Authority of Elba, Al, Inc.

Doing business as Lance K. Dyess, MD

  • Family Medicine Physician
  • Elba, AL
National Provider Identifier
1972653210
Registry record updated Dec 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10790 Issued in AL
Legal business name
HEALTHCARE AUTHORITY OF ELBA, AL, INC.
Doing business as
Lance K. Dyess, MD
Practice address
918 Drayton Ave
Elba, AL 36323-1448
Phone
(334) 897-2207
Fax
(334) 897-3476
NPI assigned
Jan 11, 2007
Last updated
Dec 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2011

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

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 10790 AL Primary

Addresses

Primary practice location

918 Drayton Ave
Elba, AL 36323-1448

Mailing address

918 Drayton Ave
Elba, AL 36323-1448
Phone (334) 897-2207

Other identifiers 2

IdentifierTypeStateIssuer
0510078620OtherALBCBS OF AL
009918640MedicaidAL

Other names 1

  • Lance K. Dyess, MD Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325203200000",
    "number": "1972653210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "918 DRAYTON AVE",
            "city": "ELBA",
            "state": "AL",
            "postal_code": "363231448",
            "telephone_number": "334-897-2207",
            "fax_number": "334-897-3476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 DRAYTON AVE",
            "city": "ELBA",
            "state": "AL",
            "postal_code": "363231448",
            "telephone_number": "334-897-2207",
            "fax_number": "334-897-3476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHCARE AUTHORITY OF ELBA, AL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2011-12-30",
        "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": "10790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF AL",
            "identifier": "0510078620",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009918640",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lance K. Dyess, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elba, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2011; 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.