| De Integro Llc | |
|
187 Belmont Dr Dothan AL 36305-6500 | |
| (334) 671-1280 | |
| Not Available |
| Full Name | De Integro Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 187 Belmont Dr, Dothan, Alabama |
| Authorized Official Name and Position | Jeremiah Garrett Dalton (OWNER) |
| Authorized Official Contact | 3347961485 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| De Integro Llc 232 Pebble Creek Dr Ozark AL 36360-4709 Ph: (334) 796-1485 | De Integro Llc 187 Belmont Dr Dothan AL 36305-6500 Ph: (334) 671-1280 |
| NPI Number | 1427838580 |
|---|---|
| Provider Enumeration Date | 10/04/2023 |
| Last Update Date | 10/04/2023 |
| Certification Date | 10/04/2023 |
| Medicare PECOS PAC ID | 5698114924 |
|---|---|
| Medicare Enrollment ID | O20240418002645 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427838580 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jeremiah G Dalton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487161279 PECOS PAC ID: 2567801897 Enrollment ID: I20240418003019 |
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