Provider Demographics
NPI:1013399625
Name:SOUTHEAST ALABAMA REGIONAL HEALTHCARE AUTHORITY
Entity Type:Organization
Organization Name:SOUTHEAST ALABAMA REGIONAL HEALTHCARE AUTHORITY
Other - Org Name:EUFAULA FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-688-7128
Mailing Address - Street 1:820 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1822
Mailing Address - Country:US
Mailing Address - Phone:334-688-7128
Mailing Address - Fax:334-688-7127
Practice Address - Street 1:617B E BROAD ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1710
Practice Address - Country:US
Practice Address - Phone:334-688-7000
Practice Address - Fax:334-688-7127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty