Provider Demographics
NPI:1538118666
Name:FOLEY CLINIC CORP
Entity Type:Organization
Organization Name:FOLEY CLINIC CORP
Other - Org Name:ORANGE BEACH FAMILY MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7626
Mailing Address - Street 1:7100 COMMERCE WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2829
Mailing Address - Country:US
Mailing Address - Phone:615-465-7000
Mailing Address - Fax:
Practice Address - Street 1:4223 ORANGE BEACH BLVD
Practice Address - Street 2:STE. B
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-3409
Practice Address - Country:US
Practice Address - Phone:251-981-8550
Practice Address - Fax:251-981-5753
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOLEY CLINIC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-08
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK649Medicare PIN