Healthcare Provider Details

I. General information

NPI: 1689921355
Provider Name (Legal Business Name): MEDICAL OUTREACH MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5741 CARMICHAEL PKWY
MONTGOMERY AL
36117-2359
US

IV. Provider business mailing address

5741 CARMICHAEL PKWY
MONTGOMERY AL
36117-2359
US

V. Phone/Fax

Practice location:
  • Phone: 334-281-8008
  • Fax: 334-558-0357
Mailing address:
  • Phone: 334-281-8008
  • Fax: 334-558-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1-116511
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MOLLY STONE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 334-281-8008