MEDICARE: ELKMONT COMMUNITY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1194207084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELKMONT COMMUNITY CARE

Provider Business Mailing Address
First Line	:	25442 AL HIGHWAY 127
Second Line	:
City	:	ELKMONT
State	:	AL
Zip	:	35620-6608
Country	:	US
Telephone Number	:	256-732-3712
Fax Number	:	256-732-3714

Provider Business Practice Location Address
First Line	:	25442 AL HIGHWAY 127
Second Line	:
City	:	ELKMONT
State	:	AL
Zip	:	35620-6608
Country	:	US
Telephone Number	:	256-732-3712
Fax Number	:	256-732-3714

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SEBRINA B HOLT
Credential	:
Telephone Number	:	256-216-9648

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	01/05/2024

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Directions to “ELKMONT COMMUNITY CARE ” Practice Location

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