Provider Demographics
NPI:1659539435
Name:LUVERNE HEALTH CLINIC, P.A.
Entity Type:Organization
Organization Name:LUVERNE HEALTH CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-335-6515
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-0407
Mailing Address - Country:US
Mailing Address - Phone:334-335-6515
Mailing Address - Fax:334-335-2105
Practice Address - Street 1:39 ROY BEALL DR
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-6805
Practice Address - Country:US
Practice Address - Phone:334-335-6515
Practice Address - Fax:334-335-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6744174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000006567Medicaid
AL1639258254Medicare PIN
ALC74281Medicare UPIN