| |
1845 Cherry St Montgomery AL 36107-2613 | |
(334) 420-5001 | |
(334) 420-0146 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1845 Cherry St, Montgomery, Alabama |
Authorized Official Name and Position | Tracy Riedler (HUMAN RESOURCES DIRECTOR) |
Authorized Official Contact | 3344205001 |
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 70365 Montgomery AL 36107-0365 Ph: (334) 420-5001 | 1845 Cherry St Montgomery AL 36107-2613 Ph: (334) 420-5001 |
NPI Number | 1205844719 |
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Provider Enumeration Date | 08/03/2006 |
Last Update Date | 04/28/2020 |
Medicare PECOS PAC ID | 1557324811 |
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Medicare Enrollment ID | O20100625000144 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205844719 | NPI | - | NPPES |
01D0027238 | Other | AL | CLIA |
630000009 | Medicaid | AL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Shabnam Guard |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1255594479 PECOS PAC ID: 7618274226 Enrollment ID: I20160328000234 |
Provider Name | Audrey Fields |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1023509932 PECOS PAC ID: 4183978240 Enrollment ID: I20210322000565 |
Your Doctor's Office, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8630 Vaughn Rd, Montgomery, AL 36117 Phone: 334-676-4076 Fax: 334-676-4064 | |
Aikam Health Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2895 Zelda Rd, Montgomery, AL 36106 Phone: 334-245-5969 | |