| Medical Park Family Care | |
|
1034 S Tallassee St Dadeville AL 36853-1844 | |
| (256) 825-9900 | |
| (256) 825-6620 |
| Full Name | Medical Park Family Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 1034 S Tallassee St, Dadeville, Alabama |
| Authorized Official Name and Position | Lother E Peace (PRESIDENT/CEO) |
| Authorized Official Contact | 2563297147 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Park Family Care 1034 S Tallassee St Dadeville AL 36853-1844 Ph: (256) 825-9900 | Medical Park Family Care 1034 S Tallassee St Dadeville AL 36853-1844 Ph: (256) 825-9900 |
| NPI Number | 1215953799 |
|---|---|
| Provider Enumeration Date | 07/15/2006 |
| Last Update Date | 02/13/2024 |
| Medicare PECOS PAC ID | 6406754431 |
|---|---|
| Medicare Enrollment ID | O20190712000891 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215953799 | NPI | - | NPPES |
| CH4859 | Other | AL | RAILROAD MEDICARE |
| 529906130 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 11873 (Alabama) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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