<unavail> in Dothan, AL - Medicare Clinic/Center

is a medicare enrolled primary clinic (Clinic/center - Primary Care) in Dothan, Alabama. The current practice location for is 3332 W Main St Ste 2, Dothan, Alabama. For appointments, you can reach them via phone at (719) 661-6033. The mailing address for is 3332 W Main St Ste 2, Dothan, Alabama and phone number is (334) 246-2577.

is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1427710896. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (719) 661-6033.

Contact Information


	3332 W Main St Ste 2 Dothan AL 36305-1019
	(719) 661-6033
	Not Available

Map and Direction

Primary Care Clinic Profile

Full Name
Speciality	Clinic/Center
Location	3332 W Main St Ste 2, Dothan, Alabama
Authorized Official Name and Position	Kelley E Blake (NURSE PRACTITIONER)
Authorized Official Contact	7196616033
Accepts Medicare Insurance	Yes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
3332 W Main St Ste 2 Dothan AL 36305-1019 Ph: (334) 246-2577	3332 W Main St Ste 2 Dothan AL 36305-1019 Ph: (719) 661-6033

NPI Details:

NPI Number	1427710896
Provider Enumeration Date	10/12/2021
Last Update Date	06/18/2024

Medicare PECOS Information:

Medicare PECOS PAC ID	5294121935
Medicare Enrollment ID	O20220406002136

Medical Identifiers

Medical identifiers for such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1427710896	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
261QP2300X	Clinic/center - Primary Care	(* (Not Available))	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. acts as a billing entity for following providers:

Provider Name	Philip T Wilson
Provider Type	Practitioner - Family Practice
Provider Identifiers	NPI Number: 1811256084 PECOS PAC ID: 5294972386 Enrollment ID: I20130509000066

Provider Name	Kelley E Blake
Provider Type	Practitioner - Nurse Practitioner
Provider Identifiers	NPI Number: 1770737249 PECOS PAC ID: 4981768694 Enrollment ID: I20151201003172

Provider Name	Marcey Nicholas
Provider Type	Practitioner - Nurse Practitioner
Provider Identifiers	NPI Number: 1972209153 PECOS PAC ID: 5092162651 Enrollment ID: I20231103002631

Provider Name	Jacqueline O'kane
Provider Type	Practitioner - Family Practice
Provider Identifiers	NPI Number: 1396085981 PECOS PAC ID: 3870815970 Enrollment ID: I20241126001693

Reviews and Comments

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- Medicare Primary Care in Dothan, AL