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3805 Sipsey Road Sipsey AL 35584-0080 | |
(205) 648-5337 | |
(205) 648-5411 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3805 Sipsey Road, Sipsey, Alabama |
Authorized Official Name and Position | David E Gay (CEO) |
Authorized Official Contact | 2057586647 |
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 2400 Tuscaloosa AL 35403-2400 Ph: (205) 349-3250 | 3805 Sipsey Road Sipsey AL 35584-0080 Ph: (205) 648-5337 |
NPI Number | 1356369078 |
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Provider Enumeration Date | 07/18/2006 |
Last Update Date | 05/17/2022 |
Medicare PECOS PAC ID | 8224921705 |
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Medicare Enrollment ID | O20101117000955 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356369078 | NPI | - | NPPES |
630008005 | Medicaid | AL |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |