Provider Demographics
NPI:1225315468
Name:NORTHWEST MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL CENTER INC.
Other - Org Name:SULLIGENT MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-487-7555
Mailing Address - Street 1:1390 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SULLIGENT
Mailing Address - State:AL
Mailing Address - Zip Code:35586-3841
Mailing Address - Country:US
Mailing Address - Phone:205-698-7111
Mailing Address - Fax:205-698-0516
Practice Address - Street 1:1390 WALNUT ST
Practice Address - Street 2:
Practice Address - City:SULLIGENT
Practice Address - State:AL
Practice Address - Zip Code:35586-3841
Practice Address - Country:US
Practice Address - Phone:205-698-7111
Practice Address - Fax:205-698-0516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST MEDICAL CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-15
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL013970Medicare Oscar/Certification