Provider Demographics
NPI:1336139401
Name:CLARKE COUNTY HEALTHCARE LLC
Entity Type:Organization
Organization Name:CLARKE COUNTY HEALTHCARE LLC
Other - Org Name:SOUTHWEST ALABAMA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORA
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-636-4431
Mailing Address - Street 1:33700 HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-3335
Mailing Address - Country:US
Mailing Address - Phone:334-636-4431
Mailing Address - Fax:334-636-6129
Practice Address - Street 1:33700 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-3335
Practice Address - Country:US
Practice Address - Phone:334-636-4431
Practice Address - Fax:334-636-6129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL282E00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered282E00000XHospitalsLong Term Care Hospital
Not Answered282N00000XHospitalsGeneral Acute Care Hospital