Provider Demographics
NPI:1790849867
Name:MEDICOM LLC
Entity Type:Organization
Organization Name:MEDICOM LLC
Other - Org Name:ARAB CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELRICK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:256-931-2035
Mailing Address - Street 1:137 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARAB
Mailing Address - State:AL
Mailing Address - Zip Code:35016-1354
Mailing Address - Country:US
Mailing Address - Phone:256-931-2035
Mailing Address - Fax:256-931-0634
Practice Address - Street 1:137 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ARAB
Practice Address - State:AL
Practice Address - Zip Code:35016-1354
Practice Address - Country:US
Practice Address - Phone:256-931-2035
Practice Address - Fax:256-931-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty