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111 Main Street Thomaston AL 36783-0276 | |
(334) 627-3497 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 111 Main Street, Thomaston, Alabama |
Authorized Official Name and Position | Latoya Freeman (HR DIRECTOR) |
Authorized Official Contact | 3348747428 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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111 Main Street Thomaston AL 36783-0276 Ph: (334) 627-3497 | 111 Main Street Thomaston AL 36783-0276 Ph: (334) 627-3497 |
NPI Number | 1215471032 |
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Provider Enumeration Date | 12/13/2016 |
Last Update Date | 03/02/2017 |
Medicare PECOS PAC ID | 0143219196 |
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Medicare Enrollment ID | O20170622002894 |
Identifier | Type | State | Issuer |
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1215471032 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |