Full Name | |
---|---|
Speciality | Family Medicine |
Location | 252 Larkin Rd, Elba, Alabama |
Authorized Official Name and Position | Lance K Dyess (PHYSICIAN/OWNER) |
Authorized Official Contact | 3348972207 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
252 Larkin Rd Elba AL 36323-5102 Ph: (334) 897-2207 | 252 Larkin Rd Elba AL 36323-5102 Ph: (334) 897-2207 |
NPI Number | 1124376686 |
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Provider Enumeration Date | 08/15/2012 |
Last Update Date | 08/15/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124376686 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 10790 (Alabama) | Primary |
Mizell Memorial Hospital, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 918 Drayton Ave, Elba, AL 36323 Phone: 334-493-5713 | |