Provider Demographics
NPI:1457381261
Name:DOCTORS CLINIC OF MONROEVILLE PC
Entity Type:Organization
Organization Name:DOCTORS CLINIC OF MONROEVILLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC.TRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOROUGHS
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:251-575-4825
Mailing Address - Street 1:75 HIGHWAY 136 W
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460
Mailing Address - Country:US
Mailing Address - Phone:251-575-4825
Mailing Address - Fax:251-575-4825
Practice Address - Street 1:75 HIGHWAY 136 W
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460
Practice Address - Country:US
Practice Address - Phone:251-575-4825
Practice Address - Fax:251-575-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528700740Medicaid