Provider Demographics
NPI:1518085695
Name:CLARKE COUNTY INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:CLARKE COUNTY INTERNAL MEDICINE LLC
Other - Org Name:CLARKE COUNTY INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO SOUTHWEST ALABAMA MEDICAL
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERSCHENC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-636-4431
Mailing Address - Street 1:411 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784
Mailing Address - Country:US
Mailing Address - Phone:334-636-5696
Mailing Address - Fax:334-636-0086
Practice Address - Street 1:411 WILSON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784
Practice Address - Country:US
Practice Address - Phone:334-636-5696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty