Healthcare Provider Details

I. General information

NPI: 1891982088
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

1852 BELTLINE ROAD SUITE A
DECATUR AL
35601-0000
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 256-353-0178
  • Fax: 256-353-6723
Mailing address:
  • Phone: 256-381-3308
  • Fax: 256-353-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number157945
License Number StateAL

VIII. Authorized Official

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