Provider Demographics
NPI:1154443430
Name:MOBILE COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:MOBILE COUNTY BOARD OF HEALTH
Other - Org Name:MT. VERNON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FAMILY HEALTH CLINICAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STIEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH
Authorized Official - Phone:251-690-8833
Mailing Address - Street 1:251 N BAYOU ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36603-5827
Mailing Address - Country:US
Mailing Address - Phone:251-690-8158
Mailing Address - Fax:251-690-8853
Practice Address - Street 1:19180 SHEPHERD LAKE RD
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:AL
Practice Address - Zip Code:36560-9507
Practice Address - Country:US
Practice Address - Phone:251-829-4881
Practice Address - Fax:251-829-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)