Healthcare Provider Details

I. General information

NPI: 1407953714
Provider Name (Legal Business Name): THE HEALTH CARE AUTHORITY OF THE TOWN OF WEDOWEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MAIN ST
WEDOWEE AL
36278-5139
US

IV. Provider business mailing address

209 MAIN ST S PO BOX 307
WEDOWEE AL
36278-5139
US

V. Phone/Fax

Practice location:
  • Phone: 256-357-2111
  • Fax: 256-357-2089
Mailing address:
  • Phone: 256-357-2111
  • Fax: 256-357-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKE ALEXANDER
Title or Position: ADMINISTRATOR
Credential:
Phone: 256-357-2111