| Live Oak Elementary School-based Health Center | |
|
4529 Gillionville Rd Albany GA 31721-9566 | |
| (229) 405-6188 | |
| (229) 299-4143 |
| Full Name | Live Oak Elementary School-based Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 4529 Gillionville Rd, Albany, Georgia |
| Authorized Official Name and Position | Shelley Spires (CEO) |
| Authorized Official Contact | 2298886559 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Oak Elementary School-based Health Center 204 N Westover Blvd Albany GA 31707-2983 Ph: (229) 888-6559 | Live Oak Elementary School-based Health Center 4529 Gillionville Rd Albany GA 31721-9566 Ph: (229) 405-6188 |
| NPI Number | 1467967588 |
|---|---|
| Provider Enumeration Date | 12/12/2017 |
| Last Update Date | 12/12/2017 |
| Medicare PECOS PAC ID | 7911811922 |
|---|---|
| Medicare Enrollment ID | O20180307002724 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467967588 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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