Provider Demographics
NPI:1275184848
Name:RMCCA CLINIC B, LLC
Entity type:Organization
Organization Name:RMCCA CLINIC B, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRACTICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-382-2681
Mailing Address - Street 1:P.O. BOX 1066
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-1066
Mailing Address - Country:US
Mailing Address - Phone:334-382-0085
Mailing Address - Fax:334-383-2596
Practice Address - Street 1:29 LV STABLER DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037
Practice Address - Country:US
Practice Address - Phone:334-382-0085
Practice Address - Fax:334-383-2596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-25
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL322943Medicaid