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4350 Cleveland Ave Walnut Grove AL 35952 | |
(205) 589-6361 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 4350 Cleveland Ave, Walnut Grove, Alabama |
Authorized Official Name and Position | Wayne Rowe (CEO) |
Authorized Official Contact | 2564920131 |
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 97 Gadsden AL 35902-0097 Ph: (256) 492-0131 | 4350 Cleveland Ave Walnut Grove AL 35952 Ph: (205) 589-6361 |
NPI Number | 1588615959 |
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Provider Enumeration Date | 05/12/2006 |
Last Update Date | 01/18/2017 |
Medicare PECOS PAC ID | 7810890902 |
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Medicare Enrollment ID | O20100315000268 |
Identifier | Type | State | Issuer |
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1588615959 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |