Provider Demographics
NPI:1093349953
Name:CAPSTONE HEALTH
Entity Type:Organization
Organization Name:CAPSTONE HEALTH
Other - Org Name:CAPSTONE NAUVOO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FOSTER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:205-686-5113
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:AL
Mailing Address - Zip Code:35580-0169
Mailing Address - Country:US
Mailing Address - Phone:205-686-5113
Mailing Address - Fax:205-686-5145
Practice Address - Street 1:156 3RD AVE
Practice Address - Street 2:
Practice Address - City:NAUVOO
Practice Address - State:AL
Practice Address - Zip Code:35578-3238
Practice Address - Country:US
Practice Address - Phone:205-724-9059
Practice Address - Fax:205-697-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL178831Medicaid