Provider Demographics
NPI:1790021533
Name:PICKENS COUNTY MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:PICKENS COUNTY MEDICAL CENTER, INC
Other - Org Name:REFORM PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UNIT LEADER PHYSICIAN SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-367-8111
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:AL
Mailing Address - Zip Code:35447-0347
Mailing Address - Country:US
Mailing Address - Phone:205-367-8111
Mailing Address - Fax:205-367-2121
Practice Address - Street 1:514 10TH AVE SW
Practice Address - Street 2:
Practice Address - City:REFORM
Practice Address - State:AL
Practice Address - Zip Code:35481-2114
Practice Address - Country:US
Practice Address - Phone:205-375-6251
Practice Address - Fax:205-375-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health