Healthcare Provider Details

I. General information

NPI: 1033354477
Provider Name (Legal Business Name): REFORM MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 10TH AVENUE SOUTH WEST
REFORM AL
35481-0670
US

IV. Provider business mailing address

514 10TH AVENUE SOUTH WEST
REFORM AL
35481-0670
US

V. Phone/Fax

Practice location:
  • Phone: 205-375-6251
  • Fax: 205-375-9064
Mailing address:
  • Phone: 205-375-6251
  • Fax: 205-375-9064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number11725
License Number StateAL

VIII. Authorized Official

Name: DR. HARRY LEE RICHARDSON
Title or Position: MEDICARL DOCTOR
Credential: MD
Phone: 205-375-6251