Provider Demographics
NPI:1760930200
Name:ATTENTUS MOULTON, LLC
Entity Type:Organization
Organization Name:ATTENTUS MOULTON, LLC
Other - Org Name:MOULTON PRIMARY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING/BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-974-2207
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-0340
Mailing Address - Country:US
Mailing Address - Phone:256-974-2207
Mailing Address - Fax:256-974-8211
Practice Address - Street 1:40 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1256
Practice Address - Country:US
Practice Address - Phone:256-974-0606
Practice Address - Fax:256-522-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health