Provider Demographics
NPI:1477979672
Name:RMCCA CLINIC A, LLC
Entity Type:Organization
Organization Name:RMCCA CLINIC A, LLC
Other - Org Name:REGIONAL MEDICAL CENTER CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-371-5025
Mailing Address - Street 1:300 N COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037
Mailing Address - Country:US
Mailing Address - Phone:334-382-2681
Mailing Address - Fax:334-383-9884
Practice Address - Street 1:300 N COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037
Practice Address - Country:US
Practice Address - Phone:334-382-2681
Practice Address - Fax:334-383-9884
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEALTH CARE AUTHORITY OF THE CITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-12
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL170603Medicaid