Summerdale Medical Clinic | |
511 State Highway 59 N Summerdale AL 36580-3686 | |
(256) 550-1415 | |
Not Available |
Full Name | Summerdale Medical Clinic |
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Speciality | Clinic/Center |
Location | 511 State Highway 59 N, Summerdale, Alabama |
Authorized Official Name and Position | Amanda Maddox (BUSINESS OWNER) |
Authorized Official Contact | 2519899400 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Summerdale Medical Clinic Po Box 703 Summerdale AL 36580-0703 Ph: () - | Summerdale Medical Clinic 511 State Highway 59 N Summerdale AL 36580-3686 Ph: (256) 550-1415 |
NPI Number | 1285374470 |
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Provider Enumeration Date | 03/29/2022 |
Last Update Date | 10/17/2022 |
Medicare PECOS PAC ID | 5799162723 |
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Medicare Enrollment ID | O20220513000575 |
Identifier | Type | State | Issuer |
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1285374470 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Amanda Maddox |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073109708 PECOS PAC ID: 8729494174 Enrollment ID: I20210309001995 |
Provider Name | Ethan S. Sellers |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1871080986 PECOS PAC ID: 4284035031 Enrollment ID: I20210630001771 |
Summerdale Family Medicine, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 Highway 59 N, Summerdale, AL 36580 Phone: 251-989-9400 Fax: 251-989-2090 |