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3945 Broad St Pine Hill AL 36769-3126 | |
(334) 963-2113 | |
(334) 963-2113 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3945 Broad St, Pine Hill, Alabama |
Authorized Official Name and Position | Elizabeth M Kennedy (ADMINISTRATOR) |
Authorized Official Contact | 3346824131 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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317 Mcwilliams Ave Camden AL 36726-1610 Ph: (334) 682-4131 | 3945 Broad St Pine Hill AL 36769-3126 Ph: (334) 963-2113 |
NPI Number | 1548674013 |
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Provider Enumeration Date | 06/12/2014 |
Last Update Date | 07/18/2014 |
Medicare PECOS PAC ID | 8224099072 |
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Medicare Enrollment ID | O20140915002286 |
Identifier | Type | State | Issuer |
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1548674013 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |