| |
1080 Reservation Rd Mount Vernon AL 36560 | |
(251) 829-9884 | |
(251) 866-9121 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 1080 Reservation Rd, Mount Vernon, Alabama |
Authorized Official Name and Position | Susan Stiegler (DIRECTOR FAMILY HEALTH CLINICAL SER) |
Authorized Official Contact | 2516908833 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 2867 Mobile AL 36652-2867 Ph: (251) 690-8158 | 1080 Reservation Rd Mount Vernon AL 36560 Ph: (251) 829-9884 |
NPI Number | 1972698199 |
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Provider Enumeration Date | 10/04/2006 |
Last Update Date | 07/17/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1972698199 | NPI | - | NPPES |
630000013 | Medicaid | AL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |