Provider Demographics
NPI:1083164099
Name:SOUTHEAST ALABAMA REGIONAL HEALTHCARE AUTHORITY
Entity Type:Organization
Organization Name:SOUTHEAST ALABAMA REGIONAL HEALTHCARE AUTHORITY
Other - Org Name:LAKE EUFAULA PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-688-7451
Mailing Address - Street 1:130 N RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1631
Mailing Address - Country:US
Mailing Address - Phone:334-688-7451
Mailing Address - Fax:
Practice Address - Street 1:130 N RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1631
Practice Address - Country:US
Practice Address - Phone:334-688-7451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD33968261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care