Provider Demographics
NPI:1922134865
Name:THE HEALTH CARE AUTHORITY OF LAUDERDALE COUNTY AND THE CITY OF FLORENC
Entity Type:Organization
Organization Name:THE HEALTH CARE AUTHORITY OF LAUDERDALE COUNTY AND THE CITY OF FLORENC
Other - Org Name:THE MEDICAL CLINIC AT ECM EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:PIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-768-9191
Mailing Address - Street 1:PO BOX 10005
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-2005
Mailing Address - Country:US
Mailing Address - Phone:256-768-9191
Mailing Address - Fax:256-768-9775
Practice Address - Street 1:2115 CLOYD BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-7512
Practice Address - Country:US
Practice Address - Phone:256-760-9003
Practice Address - Fax:256-760-9095
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEALTH CARE AUTHORITY OF LAUDERDALE COUNTY AND THE CITY OF FLORENC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-26
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALH3902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC896Medicare PIN