| Spectracare Integrated Services Llc | |
|
3542 Montgomery Hwy Dothan AL 36303-2165 | |
| (334) 712-2720 | |
| (334) 712-2727 |
| Full Name | Spectracare Integrated Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3542 Montgomery Hwy, Dothan, Alabama |
| Authorized Official Name and Position | Melissa Kirkland (CHIEF EXECTUTIVE OFFICER) |
| Authorized Official Contact | 3347122720 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectracare Integrated Services Llc Po Box 1245 Dothan AL 36302-1245 Ph: (334) 712-2720 | Spectracare Integrated Services Llc 3542 Montgomery Hwy Dothan AL 36303-2165 Ph: (334) 712-2720 |
| NPI Number | 1205385176 |
|---|---|
| Provider Enumeration Date | 10/03/2016 |
| Last Update Date | 10/03/2016 |
| Medicare PECOS PAC ID | 8921386798 |
|---|---|
| Medicare Enrollment ID | O20161028001477 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205385176 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Fernando Lopez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659391951 PECOS PAC ID: 7810980950 Enrollment ID: I20040406000094 |
| Provider Name | Esiri Esin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013147990 PECOS PAC ID: 4284778259 Enrollment ID: I20100927000264 |
| Provider Name | Danielle Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679114532 PECOS PAC ID: 0345672838 Enrollment ID: I20191121003154 |
| Provider Name | Amanda Louise Baine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528663275 PECOS PAC ID: 0648685008 Enrollment ID: I20210216003240 |
| Provider Name | Bobbi Houston Pippins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891485173 PECOS PAC ID: 8628434123 Enrollment ID: I20230524003273 |
| Provider Name | Brittnee Beck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407546021 PECOS PAC ID: 9537527148 Enrollment ID: I20230614000249 |
| Provider Name | Jenny Lee Bell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811644503 PECOS PAC ID: 8527429349 Enrollment ID: I20230726002626 |
| Provider Name | Lisa Colvin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639937840 PECOS PAC ID: 8325488604 Enrollment ID: I20240503000914 |
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