Provider Demographics
NPI:1912220476
Name:MEDCARE CLINIC LLC
Entity Type:Organization
Organization Name:MEDCARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZZAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-267-0870
Mailing Address - Street 1:5519 HIGHWAY 22 E
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-7035
Mailing Address - Country:US
Mailing Address - Phone:256-267-0870
Mailing Address - Fax:
Practice Address - Street 1:2060 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3439
Practice Address - Country:US
Practice Address - Phone:256-267-0870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084184261Q00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center