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950 East Coy Smith Hwy Mount Vernon AL 36560-3201 | |
(251) 829-9884 | |
(251) 829-9507 |
Full Name | |
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Speciality | Clinic/Center |
Location | 950 East Coy Smith Hwy, Mount Vernon, Alabama |
Authorized Official Name and Position | Kelly Warren (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2516908158 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 2867 Mobile AL 36652-2867 Ph: (251) 690-8158 | 950 East Coy Smith Hwy Mount Vernon AL 36560-3201 Ph: (251) 829-9884 |
NPI Number | 1639474778 |
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Provider Enumeration Date | 01/21/2011 |
Last Update Date | 04/29/2021 |
Medicare PECOS PAC ID | 9931208386 |
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Medicare Enrollment ID | O20120404001041 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639474778 | NPI | - | NPPES |
126108 | Medicaid | AL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |