Provider Demographics
NPI:1720090756
Name:CLANTON HOSPITAL LLC
Entity Type:Organization
Organization Name:CLANTON HOSPITAL LLC
Other - Org Name:NORTHSIDE FAMILY PRACTICE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:TURNER
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-688-3888
Mailing Address - Street 1:21850 U S HWY 31
Mailing Address - Street 2:
Mailing Address - City:THORSBY
Mailing Address - State:AL
Mailing Address - Zip Code:35171
Mailing Address - Country:US
Mailing Address - Phone:205-688-3888
Mailing Address - Fax:205-688-3895
Practice Address - Street 1:21850 U S HWY 31
Practice Address - Street 2:
Practice Address - City:THORSBY
Practice Address - State:AL
Practice Address - Zip Code:35171
Practice Address - Country:US
Practice Address - Phone:205-688-3888
Practice Address - Fax:205-688-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center