Full Name | |
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Speciality | Clinic/Center |
Location | 218 Main St, Fulton, Alabama |
Authorized Official Name and Position | Farrell A Turner (CEO) |
Authorized Official Contact | 3346365311 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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24b Camden Byp Camden AL 36726-1770 Ph: (334) 882-1919 | 218 Main St Fulton AL 36446 Ph: (334) 636-4823 |
NPI Number | 1376211011 |
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Provider Enumeration Date | 08/30/2021 |
Last Update Date | 02/13/2023 |
Medicare PECOS PAC ID | 2961809736 |
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Medicare Enrollment ID | O20211026001286 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376211011 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |