Provider Demographics
NPI:1457429516
Name:CLEBURNE MEDICAL CLINIC
Entity Type:Organization
Organization Name:CLEBURNE MEDICAL CLINIC
Other - Org Name:ANNISTON GERIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-237-2351
Mailing Address - Street 1:1112 CHRISTINE AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4658
Mailing Address - Country:US
Mailing Address - Phone:256-237-2351
Mailing Address - Fax:256-237-2350
Practice Address - Street 1:1112 CHRISTINE AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4658
Practice Address - Country:US
Practice Address - Phone:256-237-2351
Practice Address - Fax:256-237-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI239Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER