Provider Demographics
NPI:1134473952
Name:PICKENS COUNTY HEALTH CARE AUTHORITY
Entity Type:Organization
Organization Name:PICKENS COUNTY HEALTH CARE AUTHORITY
Other - Org Name:GORDO PRIMARY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UNIT LEADER PHYSICIAN SEVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-367-8111
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:AL
Mailing Address - Zip Code:35447-0360
Mailing Address - Country:US
Mailing Address - Phone:205-364-7135
Mailing Address - Fax:205-364-8244
Practice Address - Street 1:27340 HIGHWAY 86
Practice Address - Street 2:
Practice Address - City:GORDO
Practice Address - State:AL
Practice Address - Zip Code:35466-3578
Practice Address - Country:US
Practice Address - Phone:205-364-7135
Practice Address - Fax:205-364-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care