Provider Demographics
NPI:1609891449
Name:S & K PC
Entity Type:Organization
Organization Name:S & K PC
Other - Org Name:DAPHNE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:POWELL
Authorized Official - Last Name:SCHRUBBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-621-6520
Mailing Address - Street 1:27961 US HWY 98
Mailing Address - Street 2:STE 20
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526
Mailing Address - Country:US
Mailing Address - Phone:251-621-6520
Mailing Address - Fax:251-621-6521
Practice Address - Street 1:27961 US HWY 98
Practice Address - Street 2:STE 20
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526
Practice Address - Country:US
Practice Address - Phone:251-621-6520
Practice Address - Fax:251-621-6521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529913870Medicaid
J073Medicare ID - Type Unspecified