Provider Demographics
NPI:1114252814
Name:MAZLYNN HEATHCARE SERVICE
Entity Type:Organization
Organization Name:MAZLYNN HEATHCARE SERVICE
Other - Org Name:MAZLYNN FAMILY HEATHCEARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-714-8384
Mailing Address - Street 1:P O BOX 1104
Mailing Address - Street 2:
Mailing Address - City:SLOCOMB
Mailing Address - State:AL
Mailing Address - Zip Code:36375-1104
Mailing Address - Country:US
Mailing Address - Phone:334-886-7050
Mailing Address - Fax:
Practice Address - Street 1:169 NORTH 2 AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:AR
Practice Address - Zip Code:36344
Practice Address - Country:US
Practice Address - Phone:334-714-8384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center