| Eastern Shore Internal Medicine, Llc | |
|
374 Greeno Rd S Fairhope AL 36532-1916 | |
| (251) 990-1770 | |
| (251) 990-1771 |
| Full Name | Eastern Shore Internal Medicine, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 374 Greeno Rd S, Fairhope, Alabama |
| Authorized Official Name and Position | Richard L. Snellgrove (PHYSICIAN) |
| Authorized Official Contact | 2519901770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastern Shore Internal Medicine, Llc 374 Greeno Rd S Fairhope AL 36532-1916 Ph: (251) 990-1770 | Eastern Shore Internal Medicine, Llc 374 Greeno Rd S Fairhope AL 36532-1916 Ph: (251) 990-1770 |
| NPI Number | 1891090403 |
|---|---|
| Provider Enumeration Date | 01/13/2011 |
| Last Update Date | 02/21/2011 |
| Medicare PECOS PAC ID | 0547441347 |
|---|---|
| Medicare Enrollment ID | O20110228000506 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891090403 | NPI | - | NPPES |
| 000038007 | Medicaid | AL | |
| 510-38007 | Other | AL | BC/BS |
| 25-10092 | Other | AL | UNITED HEALTHCARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 00016922 (Alabama) | Primary |
| Provider Name | Richard L Snellgrove |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366499477 PECOS PAC ID: 4183757248 Enrollment ID: I20100727000579 |
Self Center Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 306 S Greeno Rd, Suite A, Fairhope, AL 36532 Phone: 251-928-8760 Fax: 251-928-7028 | |
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