Provider Demographics
NPI:1518719699
Name:CHAMBERS COUNTY RURAL HEALTH CLINIC
Entity Type:Organization
Organization Name:CHAMBERS COUNTY RURAL HEALTH CLINIC
Other - Org Name:CHAMBERS COUNTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-844-4099
Mailing Address - Street 1:404 9TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36862-2806
Mailing Address - Country:US
Mailing Address - Phone:334-459-0188
Mailing Address - Fax:
Practice Address - Street 1:404 9TH AVE SW
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:AL
Practice Address - Zip Code:36862-2806
Practice Address - Country:US
Practice Address - Phone:334-459-0188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUBURN RURAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center