Provider Demographics
NPI:1609273408
Name:QUALITY HEALTHCARE & HOLISTIC CLINIC, LLC
Entity Type:Organization
Organization Name:QUALITY HEALTHCARE & HOLISTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:OBLENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-403-1025
Mailing Address - Street 1:PO BOX 2146
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-2146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:226 S QUINTARD AVE STE C
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-6070
Practice Address - Country:US
Practice Address - Phone:256-403-1025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051531188OtherBCBS
AL5101000072Medicare PIN
ALP00272210Medicare PIN