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12701 Padgett Switch Rd Irvington AL 36544-4011 | |
(251) 824-2174 | |
(251) 824-3444 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 12701 Padgett Switch Rd, Irvington, Alabama |
Authorized Official Name and Position | James A. Holland (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 2518242174 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 769 Bayou La Batre AL 36509-0769 Ph: (251) 824-2174 | 12701 Padgett Switch Rd Irvington AL 36544-4011 Ph: (251) 824-2174 |
NPI Number | 1811183882 |
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Provider Enumeration Date | 09/24/2007 |
Last Update Date | 09/24/2007 |
Identifier | Type | State | Issuer |
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1811183882 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | N/A (Alabama) | Primary |