Provider Demographics
NPI:1720226020
Name:RICHARD S HAMMOCK,MD DBA DALE MEDICAL CENTER
Entity Type:Organization
Organization Name:RICHARD S HAMMOCK,MD DBA DALE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-774-2601
Mailing Address - Street 1:218 HOSPITAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-2072
Mailing Address - Country:US
Mailing Address - Phone:334-774-1982
Mailing Address - Fax:334-774-7600
Practice Address - Street 1:218 HOSPITAL AVE STE A
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-2072
Practice Address - Country:US
Practice Address - Phone:334-774-1982
Practice Address - Fax:334-774-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty