| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 30 Main St, Eclectic, Alabama |
| Authorized Official Name and Position | Susie Ann Beal (CFO) |
| Authorized Official Contact | 3344205001 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 70365 Montgomery AL 36107-0365 Ph: (334) 420-5038 | 30 Main St Eclectic AL 36024-5614 Ph: (334) 541-2116 |
| NPI Number | 1982626842 |
|---|---|
| Provider Enumeration Date | 07/23/2006 |
| Last Update Date | 11/29/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982626842 | NPI | - | NPPES |
| 01D0996054 | Other | AL | CLIA |
| 630009009 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |