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6110 County Road 88 Pisgah AL 35765 | |
(256) 451-1250 | |
(256) 451-1270 |
Full Name | |
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Speciality | Clinic/Center |
Location | 6110 County Road 88, Pisgah, Alabama |
Authorized Official Name and Position | Muhammad Ejaz Ata (OWNER) |
Authorized Official Contact | 2564511250 |
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 246 Pisgah AL 35765-0246 Ph: (256) 451-1250 | 6110 County Road 88 Pisgah AL 35765 Ph: (256) 451-1250 |
NPI Number | 1679827497 |
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Provider Enumeration Date | 10/31/2012 |
Last Update Date | 10/17/2024 |
Medicare PECOS PAC ID | 0941326888 |
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Medicare Enrollment ID | O20130116000588 |
Identifier | Type | State | Issuer |
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1679827497 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |