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General NPI Number Information
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NPI Number | 1336907948
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Entity Type | Organization
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Legal Business Name | MOWA BAND OF CHOCTAW INDIANS
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Dates
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Enumeration Date | 03/08/2024
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 1080 RED FOX RD W
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City | MOUNT VERNON
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State | AL
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Zip | 36560-2629
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Country | US
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Telephone | 251-829-9023
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Fax | 855-933-1195
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Provider Business Mailing Address
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Address Line | 1080 RED FOX RD W
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City | MOUNT VERNON
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State | AL
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Zip | 36560-2629
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Country | US
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Telephone | 251-786-0829
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Fax | 855-933-1195
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Authorized Official
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Title or Position | CHIEF
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Name | LEBARON BYRD
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Credential |
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Telephone | 251-786-0829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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