Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 193 Oates Dr, Newton, Alabama |
Authorized Official Name and Position | John A Little (CEO) |
Authorized Official Contact | 3346706726 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1414 Elba Hwy Troy AL 36079-6020 Ph: (334) 670-6726 | 193 Oates Dr Newton AL 36352-4312 Ph: (334) 299-3592 |
NPI Number | 1780745034 |
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Provider Enumeration Date | 12/12/2006 |
Last Update Date | 02/20/2019 |
Medicare PECOS PAC ID | 4880726850 |
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Medicare Enrollment ID | O20100916001003 |
Identifier | Type | State | Issuer |
---|---|---|---|
1780745034 | NPI | - | NPPES |
630004018 | Medicaid | AL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |