Provider Demographics
NPI:1689769895
Name:MILLENNIUM HEALTH CLINIC
Entity Type:Organization
Organization Name:MILLENNIUM HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-835-6430
Mailing Address - Street 1:1713 HAMRIC DR E
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-2015
Mailing Address - Country:US
Mailing Address - Phone:256-835-6430
Mailing Address - Fax:256-835-6409
Practice Address - Street 1:1713 HAMRIC DR E
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-2015
Practice Address - Country:US
Practice Address - Phone:256-835-6430
Practice Address - Fax:256-835-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20323207R00000X, 2083X0100X
AL20005207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE80041Medicare UPIN
AL000033828Medicare PIN
AL1176830001Medicare NSC