Provider Demographics
NPI:1700986791
Name:PICKENS COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:PICKENS COUNTY MEDICAL CENTER
Other - Org Name:CARROLLTON PRIMARY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-367-2405
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:AL
Mailing Address - Zip Code:35447-0347
Mailing Address - Country:US
Mailing Address - Phone:205-367-8197
Mailing Address - Fax:205-367-8198
Practice Address - Street 1:184 WILLIAM E. HILL DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:AL
Practice Address - Zip Code:35447
Practice Address - Country:US
Practice Address - Phone:205-367-8197
Practice Address - Fax:205-367-8198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529922310Medicaid