| |
4300 W Main St Ste 300 Dothan AL 36305-1313 | |
(334) 446-0076 | |
(334) 406-0203 |
Full Name | |
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Speciality | Clinic/Center |
Location | 4300 W Main St Ste 300, Dothan, Alabama |
Authorized Official Name and Position | Pamylon Bowers (CEO) |
Authorized Official Contact | 3346706726 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1414 Elba Hwy Troy AL 36079-6020 Ph: (334) 670-6726 | 4300 W Main St Ste 300 Dothan AL 36305-1313 Ph: (334) 446-0076 |
NPI Number | 1194087593 |
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Provider Enumeration Date | 06/12/2012 |
Last Update Date | 09/12/2022 |
Medicare PECOS PAC ID | 4789625948 |
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Medicare Enrollment ID | O20120823000937 |
Identifier | Type | State | Issuer |
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1194087593 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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