| |
162 S Dalton St Slocomb AL 36375-5669 | |
(334) 886-3023 | |
(334) 886-3028 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 162 S Dalton St, Slocomb, Alabama |
Authorized Official Name and Position | Pamylon Bowers (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 3346706726 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1414 Elba Hwy Troy AL 36079-6020 Ph: (334) 670-6726 | 162 S Dalton St Slocomb AL 36375-5669 Ph: (334) 886-3023 |
NPI Number | 1023290608 |
---|---|
Provider Enumeration Date | 12/05/2007 |
Last Update Date | 09/12/2022 |
Medicare PECOS PAC ID | 8123009057 |
---|---|
Medicare Enrollment ID | O20080519000641 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023290608 | NPI | - | NPPES |
630007018 | Medicaid | AL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |