Healthcare Provider Details

I. General information

NPI: 1134440894
Provider Name (Legal Business Name): REFORM RURAL HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 10TH AVE SW
REFORM AL
35481
US

IV. Provider business mailing address

PO BOX 670
REFORM AL
35481-0670
US

V. Phone/Fax

Practice location:
  • Phone: 205-375-6251
  • Fax: 205-375-6121
Mailing address:
  • Phone: 205-375-6251
  • Fax: 205-375-6121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HARRY LEE RICHARDSON JR.
Title or Position: PRESIDENT/PHYSICIAN
Credential: M.D.
Phone: 205-375-6251