Provider Demographics
NPI:1073700266
Name:SOUTHERN RURAL HEALTH CARE CONSORTIUM
Entity Type:Organization
Organization Name:SOUTHERN RURAL HEALTH CARE CONSORTIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOVETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-381-3308
Mailing Address - Street 1:104 PHYSICIANS DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-0000
Mailing Address - Country:US
Mailing Address - Phone:256-381-3308
Mailing Address - Fax:256-381-1869
Practice Address - Street 1:16410 HWY 72
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35652-0000
Practice Address - Country:US
Practice Address - Phone:256-247-3154
Practice Address - Fax:256-247-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00022770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH12514Medicare UPIN
ALG550Medicare PIN