| Chisholm Family Health Center | |
|
100 E Vandiver Blvd Montgomery AL 36110-1812 | |
| (334) 832-4338 | |
| (334) 832-9971 |
| Full Name | Chisholm Family Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 100 E Vandiver Blvd, Montgomery, Alabama |
| Authorized Official Name and Position | Susie Ann Beal (CFO) |
| Authorized Official Contact | 3344205001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chisholm Family Health Center Po Box 70365 Montgomery AL 36107-0365 Ph: (334) 420-5038 | Chisholm Family Health Center 100 E Vandiver Blvd Montgomery AL 36110-1812 Ph: (334) 832-4338 |
| NPI Number | 1538181490 |
|---|---|
| Provider Enumeration Date | 07/23/2006 |
| Last Update Date | 11/29/2023 |
| Medicare PECOS PAC ID | 1557324811 |
|---|---|
| Medicare Enrollment ID | O20110622000662 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538181490 | NPI | - | NPPES |
| 01D0967316 | Other | AL | CLIA |
| 630003009 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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