Healthcare Provider Details

I. General information

NPI: 1609696079
Provider Name (Legal Business Name): HELEN KELLER SPECIALTY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S MONTGOMERY AVE
SHEFFIELD AL
35660-6334
US

IV. Provider business mailing address

PO BOX 21007
HUNTSVILLE AL
35813-5007
US

V. Phone/Fax

Practice location:
  • Phone: 256-386-4196
  • Fax:
Mailing address:
  • Phone: 256-801-6504
  • Fax: 256-801-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: CLINTON CARTER
Title or Position: CFO
Credential:
Phone: 256-265-8818