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1508 Cogswell Ave Pell City AL 35125-1243 | |
| (205) 814-1598 | |
| (205) 814-1587 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1508 Cogswell Ave, Pell City, Alabama |
| Authorized Official Name and Position | Mary Sue Suggs (OWNER) |
| Authorized Official Contact | 2058141598 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1508 Cogswell Ave Pell City AL 35125-1243 Ph: (205) 814-1598 | 1508 Cogswell Ave Pell City AL 35125-1243 Ph: (205) 814-1598 |
| NPI Number | 1447246053 |
|---|---|
| Provider Enumeration Date | 09/20/2005 |
| Last Update Date | 01/28/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447246053 | NPI | - | NPPES |
| 541003917 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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Main Street Medical Clinic Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1508 Cogswell Ave, Pell City, AL 35125 Phone: 205-814-1598 Fax: 205-814-1587 | |
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