| |
980 Drayton Ave Elba AL 36323-1404 | |
(334) 897-3800 | |
(334) 897-3804 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 980 Drayton Ave, Elba, Alabama |
Authorized Official Name and Position | Ellen C Briley (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 3348972257 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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980 Drayton Ave Elba AL 36323-1404 Ph: (334) 897-3800 | 980 Drayton Ave Elba AL 36323-1404 Ph: (334) 897-3800 |
NPI Number | 1215235072 |
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Provider Enumeration Date | 03/03/2011 |
Last Update Date | 03/03/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215235072 | NPI | - | NPPES |
91689839813 | Other | INDIVIDUAL NPI | |
M030769 | Other | AL | STATE MEDICAL LICENSE NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | M030769 (Alabama) | Primary |
Mizell Memorial Hospital, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 918 Drayton Ave, Elba, AL 36323 Phone: 334-493-5713 | |