Provider Demographics
NPI:1336336452
Name:TURNING LEAF MEDICAL, INC.
Entity Type:Organization
Organization Name:TURNING LEAF MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:E
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-872-8260
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-1470
Mailing Address - Country:US
Mailing Address - Phone:334-875-2134
Mailing Address - Fax:334-875-4331
Practice Address - Street 1:203 VAUGHAN MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6950
Practice Address - Country:US
Practice Address - Phone:334-875-2134
Practice Address - Fax:334-875-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28410207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALST00991228Medicaid
ALST00991228Medicaid