| |
204 Holman Dr Headland AL 36345-2307 | |
(334) 693-3336 | |
(334) 693-2553 |
Full Name | |
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Speciality | Family Medicine |
Location | 204 Holman Dr, Headland, Alabama |
Authorized Official Name and Position | Niel Christian Rasmussen (PRESIDENT) |
Authorized Official Contact | 3346933336 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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204 Holman Dr Headland AL 36345-2307 Ph: (334) 693-3336 | 204 Holman Dr Headland AL 36345-2307 Ph: (334) 693-3336 |
NPI Number | 1730126129 |
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Provider Enumeration Date | 06/02/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 0345267589 |
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Medicare Enrollment ID | O20051027000716 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730126129 | NPI | - | NPPES |
J071 | Other | MEDICARE GROUP NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 00021221 (Alabama) | Primary |
Provider Name | Niel C Rasmussen |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1174560916 PECOS PAC ID: 6608919022 Enrollment ID: I20100208000520 |