Provider Demographics
NPI:1427514199
Name:CAHABA MEDICAL CARE FOUNDATION
Entity type:Organization
Organization Name:CAHABA MEDICAL CARE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:WAITS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-926-2992
Mailing Address - Street 1:405 BELCHER ST
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35042-2946
Mailing Address - Country:US
Mailing Address - Phone:205-926-2992
Mailing Address - Fax:205-316-7675
Practice Address - Street 1:623 8TH AVE W
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35204-3604
Practice Address - Country:US
Practice Address - Phone:205-926-2992
Practice Address - Fax:205-316-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)