Provider Demographics
NPI:1801029822
Name:SOUTHEAST ALABAMA REGIONAL HEALTHCARE AUTHORITY
Entity Type:Organization
Organization Name:SOUTHEAST ALABAMA REGIONAL HEALTHCARE AUTHORITY
Other - Org Name:MCB FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-688-7276
Mailing Address - Street 1:820 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1822
Mailing Address - Country:US
Mailing Address - Phone:334-688-7000
Mailing Address - Fax:334-688-7127
Practice Address - Street 1:31 RAILROAD STREET
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:AL
Practice Address - Zip Code:36048
Practice Address - Country:US
Practice Address - Phone:334-688-7272
Practice Address - Fax:334-688-7127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care