| |
2129 E South Blvd Montgomery AL 36116-2409 | |
(334) 613-2200 | |
(334) 613-1973 |
Full Name | |
---|---|
Speciality | Clinic/center |
Location | 2129 E South Blvd, Montgomery, Alabama |
Authorized Official Name and Position | Russell Steven Shivers (COMMISSIONER) |
Authorized Official Contact | 3346132200 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
2129 E South Blvd Montgomery AL 36116-2409 Ph: (334) 613-2200 | 2129 E South Blvd Montgomery AL 36116-2409 Ph: (334) 613-2200 |
NPI Number | 1760529721 |
---|---|
Provider Enumeration Date | 01/31/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1760529721 | NPI | - | NPPES |
515-18210 | Other | AL | NUTRITION |
515-18212 | Other | AL | OPTHALMOLOGY |
515-18214 | Other | AL | ORTHOPEDICS |
515-18220 | Other | AL | PSYCHIATRY-PSYCHOLOGY |
515-18213 | Other | AL | ORAL MAXILOFACIAL |
515-18224 | Other | AL | SOCIAL WORKER |
515-18215 | Other | AL | OTOLARYNGOLOGY |
515-18225 | Other | AL | SPEECH THERAPY |
515-18209 | Other | AL | NURSE PRACTITIONER |
515-18219 | Other | AL | PLASTIC SURGERY |
515-18222 | Other | AL | PULMONARY |
515-18207 | Other | AL | NEPHROLOGY |
515-18208 | Other | AL | NEUROLOGY |
515-18211 | Other | AL | OCCUPATIONAL THERAPY |
515-18218 | Other | AL | PHYSICAL THERAPY |
515-18221 | Other | AL | RADIOLOGY |
515-18216 | Other | AL | PEDIATRICS |
515-18217 | Other | AL | PHYSICAL MEDICINE |
515-18223 | Other | AL | RHEUMATOLOGY |
515-18226 | Other | AL | UROLOGY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Your Doctor's Office, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8630 Vaughn Rd, Montgomery, AL 36117 Phone: 334-676-4076 Fax: 334-676-4064 | |
Aikam Health Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2895 Zelda Rd, Montgomery, AL 36106 Phone: 334-245-5969 | |