Provider Demographics
NPI:1689921355
Name:MEDICAL OUTREACH MINISTRIES
Entity Type:Organization
Organization Name:MEDICAL OUTREACH MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-281-8008
Mailing Address - Street 1:5741 CARMICHAEL PKWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2359
Mailing Address - Country:US
Mailing Address - Phone:334-281-8008
Mailing Address - Fax:334-558-0357
Practice Address - Street 1:5741 CARMICHAEL PKWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2359
Practice Address - Country:US
Practice Address - Phone:334-281-8008
Practice Address - Fax:334-558-0357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X
AL1-116511261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center