Provider Demographics
NPI:1336341072
Name:SOUTH CENTRAL MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:SOUTH CENTRAL MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-222-8525
Mailing Address - Street 1:843 S THREE NOTCH ST
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-5321
Mailing Address - Country:US
Mailing Address - Phone:334-222-8525
Mailing Address - Fax:334-222-3469
Practice Address - Street 1:843 S THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5321
Practice Address - Country:US
Practice Address - Phone:334-222-8525
Practice Address - Fax:334-222-3469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00009991207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-10420OtherBLUE CROSS PROVIDER NUMBE
ALC73113Medicare UPIN
ALI612Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER