Healthcare Provider Details

I. General information

NPI: 1255528444
Provider Name (Legal Business Name): SOUTHERN RURAL HEALTH CARE CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 6TH AVENUE SE
DECATUR AL
35601-0000
US

IV. Provider business mailing address

104 PHYSICIANS DRIVE SUITE B
MUSCLE SHAOLS AL
35661-0000
US

V. Phone/Fax

Practice location:
  • Phone: 256-340-1251
  • Fax: 256-353-0179
Mailing address:
  • Phone: 256-381-3308
  • Fax: 256-381-1869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00024320
License Number StateAL

VIII. Authorized Official

Name: MRS. MARGARET S LOVETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 256-381-3308