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8300 Crossland Loop Montgomery AL 36117-8482 | |
(334) 462-1781 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 8300 Crossland Loop, Montgomery, Alabama |
Authorized Official Name and Position | Chai Chamnong (PHYSICIAN/OWNER) |
Authorized Official Contact | 3344621781 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2257 Taylor Rd Suite 200 Montgomery AL 36117-7790 Ph: (334) 270-9914 | 8300 Crossland Loop Montgomery AL 36117-8482 Ph: (334) 462-1781 |
NPI Number | 1467756296 |
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Provider Enumeration Date | 01/09/2011 |
Last Update Date | 01/09/2011 |
Medicare PECOS PAC ID | 9931383460 |
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Medicare Enrollment ID | O20110407000668 |
Identifier | Type | State | Issuer |
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1467756296 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Thavatchai Chamnongchareonwong |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1023038353 PECOS PAC ID: 0648202101 Enrollment ID: I20050920001220 |
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