Healthcare Provider Details

I. General information

NPI: 1225104417
Provider Name (Legal Business Name): SOUTHERN RURAL HEALTH CARE CONSORTIUM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 AL HWY 20
TOWN CREEK AL
35672
US

IV. Provider business mailing address

PO BOX 970
RUSSELLVILLE AL
35653-0970
US

V. Phone/Fax

Practice location:
  • Phone: 256-332-1631
  • Fax: 256-332-4600
Mailing address:
  • Phone: 256-332-1631
  • Fax: 256-332-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateAL

VIII. Authorized Official

Name: MRS. KATHY L HALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 256-332-1631