Healthcare Provider Details

I. General information

NPI: 1013432244
Provider Name (Legal Business Name): FORT PAYNE RHC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13280 COUNTY ROAD 51
COLLINSVILLE AL
35961-4174
US

IV. Provider business mailing address

16 ATLANTIC AVE
LYNBROOK NY
11563-3046
US

V. Phone/Fax

Practice location:
  • Phone: 307-782-7560
  • Fax:
Mailing address:
  • Phone: 516-593-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMBER MORRIS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 256-927-9162