Provider Demographics
NPI:1811166333
Name:CENTRAL ALABAMA WOMEN'S CLINIC
Entity type:Organization
Organization Name:CENTRAL ALABAMA WOMEN'S CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-875-1440
Mailing Address - Street 1:1013 MEDICAL CENTER PKWY
Mailing Address - Street 2:BLD 1 SUITE 103
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6742
Mailing Address - Country:US
Mailing Address - Phone:334-875-1440
Mailing Address - Fax:334-875-1446
Practice Address - Street 1:1013 MEDICAL CENTER PKWY
Practice Address - Street 2:BLD 1 SUITE 103
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6742
Practice Address - Country:US
Practice Address - Phone:334-875-1440
Practice Address - Fax:334-875-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL8853865261QA0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC74876Medicaid