Healthcare Provider Details

I. General information

NPI: 1487059598
Provider Name (Legal Business Name): QUALITY HEALTHCARE & HOLISTIC CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S QUINTARD AVE STE C
ANNISTON AL
36201-6070
US

IV. Provider business mailing address

226 SOUTH QUINTARD AVE. STE. C
ANNISTON AL
36201
US

V. Phone/Fax

Practice location:
  • Phone: 256-403-1025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number19610
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JOSE OBLENA
Title or Position: MD
Credential:
Phone: 256-403-1025