Provider Demographics
NPI:1316034911
Name:SOUTHCARE CLINIC, P.C.
Entity Type:Organization
Organization Name:SOUTHCARE CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIBIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-880-5818
Mailing Address - Street 1:11220 MEMORIAL PKWY SW
Mailing Address - Street 2:SUITE AB
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-4415
Mailing Address - Country:US
Mailing Address - Phone:256-880-5818
Mailing Address - Fax:256-883-5346
Practice Address - Street 1:11220 MEMORIAL PKWY SW
Practice Address - Street 2:SUITE AB
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-4415
Practice Address - Country:US
Practice Address - Phone:256-880-5818
Practice Address - Fax:256-883-5346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL98764OtherBCBS
AL98764OtherNAMCI
AL98764OtherNAMCI