Provider Demographics
NPI:1366626285
Name:SOUTHEAST ALABAMA MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTHEAST ALABAMA MEDICAL CENTER
Other - Org Name:SAMC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF REHAB
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:334-712-3726
Mailing Address - Street 1:1108 ROSS CLARK CIRCLE
Mailing Address - Street 2:ATTN: PHYSICAL THERAPY DEPT
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301
Mailing Address - Country:US
Mailing Address - Phone:334-712-3726
Mailing Address - Fax:334-712-3553
Practice Address - Street 1:1108 ROSS CLARK CIR
Practice Address - Street 2:ATTN: PHYSICAL THERAPY DEPT
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3022
Practice Address - Country:US
Practice Address - Phone:334-712-3726
Practice Address - Fax:334-712-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3336282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital