Dr Sumpter D Blackmon Pa | |
321 Whiskey Run Rd Camden AL 36726-2303 | |
(334) 682-4128 | |
(334) 682-9151 |
Full Name | Dr Sumpter D Blackmon Pa |
---|---|
Speciality | Clinic/Center |
Location | 321 Whiskey Run Rd, Camden, Alabama |
Authorized Official Name and Position | Sumpter Dudley Blackmon (PRESIDENT) |
Authorized Official Contact | 3346824128 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Dr Sumpter D Blackmon Pa Po Box 699 Camden AL 36726-0699 Ph: (334) 682-4128 | Dr Sumpter D Blackmon Pa 321 Whiskey Run Rd Camden AL 36726-2303 Ph: (334) 682-4128 |
NPI Number | 1720153539 |
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Provider Enumeration Date | 11/21/2006 |
Last Update Date | 02/02/2010 |
Medicare PECOS PAC ID | 5991705881 |
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Medicare Enrollment ID | O20061227000025 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720153539 | NPI | - | NPPES |
000000454 | Medicaid | AL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 5754 (Alabama) | Primary |
Provider Name | Sumpter D Blackmon |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1972506194 PECOS PAC ID: 2365442258 Enrollment ID: I20061227000021 |
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