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140 Front Street Suite 4 Gilbertown AL 36908 | |
(251) 843-5537 | |
(251) 436-7765 |
Full Name | |
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Speciality | Clinic/Center |
Location | 140 Front Street, Gilbertown, Alabama |
Authorized Official Name and Position | Charles White (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 2514324117 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 2048 Mobile AL 36652-2048 Ph: (251) 434-8177 | 140 Front Street Suite 4 Gilbertown AL 36908 Ph: (251) 843-5537 |
NPI Number | 1093775918 |
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Provider Enumeration Date | 03/24/2006 |
Last Update Date | 08/30/2022 |
Medicare PECOS PAC ID | 1658356308 |
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Medicare Enrollment ID | O20100729000972 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093775918 | NPI | - | NPPES |
Q727 | Other | AL | BCBS |
630011014 | Medicaid | AL |