Provider Demographics
NPI:1962571539
Name:WEST ALABAMA CLINICAL CARE
Entity type:Organization
Organization Name:WEST ALABAMA CLINICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-289-1606
Mailing Address - Street 1:112 US HIGHWAY 80 E
Mailing Address - Street 2:P. O. BOX 249
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-3600
Mailing Address - Country:US
Mailing Address - Phone:334-289-1606
Mailing Address - Fax:334-289-3388
Practice Address - Street 1:112 US HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3600
Practice Address - Country:US
Practice Address - Phone:334-289-1606
Practice Address - Fax:334-289-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51551872Medicare ID - Type Unspecified