MEDICARE: SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES

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	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780745034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES

Provider Business Mailing Address
First Line	:	1414 ELBA HWY
Second Line	:
City	:	TROY
State	:	AL
Zip	:	36079-6020
Country	:	US
Telephone Number	:	334-670-6726
Fax Number	:	334-670-6731

Provider Business Practice Location Address
First Line	:	193 OATES DR
Second Line	:
City	:	NEWTON
State	:	AL
Zip	:	36352-4312
Country	:	US
Telephone Number	:	334-299-3592
Fax Number	:	334-299-3870

Authorized Official
Title or Position	:	CEO
Name	:	JOHN A LITTLE
Credential	:	MPH
Telephone Number	:	334-670-6726

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	02/20/2019

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