| Dekalb Clinic | |
|
415 Medical Center Dr Sw Fort Payne AL 35968-3421 | |
| (256) 997-2820 | |
| (256) 997-2890 |
| Full Name | Dekalb Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 415 Medical Center Dr Sw, Fort Payne, Alabama |
| Authorized Official Name and Position | Laura J Fey (SR. DIRECTOR PHYSICIAN REV CYCLE) |
| Authorized Official Contact | 6152213641 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dekalb Clinic 1573 Mallory Ln Ste 100 Brentwood TN 37027-2895 Ph: (152) 221-1400 | Dekalb Clinic 415 Medical Center Dr Sw Fort Payne AL 35968-3421 Ph: (256) 997-2820 |
| NPI Number | 1184679938 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 07/07/2023 |
| Medicare PECOS PAC ID | 6103838107 |
|---|---|
| Medicare Enrollment ID | O20060614000103 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184679938 | NPI | - | NPPES |
| 529929140 | Medicaid | AL | |
| 541003856 | Medicaid | AL |
| Provider Name | Daniel M Mince |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073568812 PECOS PAC ID: 4486648078 Enrollment ID: I20040414001577 |
| Provider Name | Lyza T Gaines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518912369 PECOS PAC ID: 1658366810 Enrollment ID: I20040416001243 |
| Provider Name | Jason A Ham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245560796 PECOS PAC ID: 5395929889 Enrollment ID: I20110407000291 |
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