Healthcare Provider Details

I. General information

NPI: 1558315689
Provider Name (Legal Business Name): CENTRE CLINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 NORTHWOOD DR
CENTRE AL
35960-1045
US

IV. Provider business mailing address

PO BOX 5009
BRENTWOOD TN
37024-5009
US

V. Phone/Fax

Practice location:
  • Phone: 256-927-4900
  • Fax: 256-927-9151
Mailing address:
  • Phone: 615-221-1400
  • Fax: 615-221-1484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SOPHIA ARWOOD
Title or Position: DIRECTOR; AUTHORIZED OFFICIAL
Credential:
Phone: 615-221-1400