MEDICARE: FORT PAYNE CLINIC CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician

General Provider Information

NPI Number	:	1457305500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT PAYNE CLINIC CORP

Provider Business Mailing Address
First Line	:	303 MEDICAL CENTER DR SW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3420
Country	:	US
Telephone Number	:	256-845-0428
Fax Number	:	256-845-0469

Provider Business Practice Location Address
First Line	:	303 MEDICAL CENTER DR SW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3420
Country	:	US
Telephone Number	:	256-845-0428
Fax Number	:	256-845-0469

Authorized Official
Title or Position	:	SENIOR VP
Name	:	MR. DAVID MILLER
Credential	:
Telephone Number	:	256-845-0428

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	08/22/2020

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Directions to “FORT PAYNE CLINIC CORP ” Practice Location

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