Healthcare Provider Details

I. General information

NPI: 1891801643
Provider Name (Legal Business Name): OAK RIDGE HEALTH SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180A OAK RIDGE AVE
MOBILE AL
36619-1851
US

IV. Provider business mailing address

4180A OAK RIDGE AVE
MOBILE AL
36619-1851
US

V. Phone/Fax

Practice location:
  • Phone: 251-666-0891
  • Fax: 251-661-0483
Mailing address:
  • Phone: 251-666-0891
  • Fax: 251-661-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number112024
License Number StateAL

VIII. Authorized Official

Name: MR. DAWSON GREGORY MOORER
Title or Position: PRESIDENT
Credential: RPH
Phone: 251-666-0891