Provider Demographics
NPI:1528207966
Name:LENOX MEDICAL CLINIC
Entity Type:Organization
Organization Name:LENOX MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-578-1163
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:3057 COUNTY ROAD 7
Mailing Address - City:REPTON
Mailing Address - State:AL
Mailing Address - Zip Code:36475-0273
Mailing Address - Country:US
Mailing Address - Phone:251-248-2223
Mailing Address - Fax:
Practice Address - Street 1:3057 COUNTY ROAD 7
Practice Address - Street 2:
Practice Address - City:REPTON
Practice Address - State:AL
Practice Address - Zip Code:36475
Practice Address - Country:US
Practice Address - Phone:251-248-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI COUNTY MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630004017Medicaid
AL01D0867799OtherCLIA