Healthcare Provider Details

I. General information

NPI: 1568915106
Provider Name (Legal Business Name): PHYSICIANS CARE OF GROVE HILL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 CLARK ST STE C&D
GROVE HILL AL
36451-3050
US

IV. Provider business mailing address

127 CLARK ST STE C&D
GROVE HILL AL
36451-3050
US

V. Phone/Fax

Practice location:
  • Phone: 334-636-5311
  • Fax: 334-636-2280
Mailing address:
  • Phone: 334-636-5311
  • Fax: 334-636-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HUEY R KIDD
Title or Position: PHYSICIAN
Credential: DO
Phone: 334-636-5311