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508 Greene St Greensboro AL 36744-2316 | |
(334) 624-4442 | |
(334) 624-1405 |
Full Name | |
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Speciality | Clinic/Center |
Location | 508 Greene St, Greensboro, Alabama |
Authorized Official Name and Position | Thomas O Lackey (ADMINISTRATOR/CEO) |
Authorized Official Contact | 3346243024 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 614 Greensboro AL 36744 Ph: (334) 624-4442 | 508 Greene St Greensboro AL 36744-2316 Ph: (334) 624-4442 |
NPI Number | 1558464511 |
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Provider Enumeration Date | 09/06/2006 |
Last Update Date | 01/28/2013 |
Medicare PECOS PAC ID | 3375528169 |
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Medicare Enrollment ID | O20090630000114 |
Identifier | Type | State | Issuer |
---|---|---|---|
1558464511 | NPI | - | NPPES |
529303070 | Medicaid | AL | |
121780 | Medicaid | AL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |