| Clinic W LLC | |
|
102 Medical Center Dr Clanton AL 35045-2332 | |
| (205) 383-5336 | |
| Not Available |
| Full Name | Clinic W LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 102 Medical Center Dr, Clanton, Alabama |
| Authorized Official Name and Position | David S. Wilson (SOLE MEMBER) |
| Authorized Official Contact | 2053835336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinic W LLC 102 Medical Center Dr Clanton AL 35045-2332 Ph: (205) 287-3900 | Clinic W LLC 102 Medical Center Dr Clanton AL 35045-2332 Ph: (205) 383-5336 |
| NPI Number | 1578087755 |
|---|---|
| Provider Enumeration Date | 07/31/2017 |
| Last Update Date | 01/10/2022 |
| Certification Date | 01/10/2022 |
| Medicare PECOS PAC ID | 5496020877 |
|---|---|
| Medicare Enrollment ID | O20171011001447 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578087755 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 26067 (Alabama) | Primary |
| 207R00000X | Internal Medicine | () | Secondary |
| Provider Name | David S Wilson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245271444 PECOS PAC ID: 0345277067 Enrollment ID: I20050725000199 |
| Provider Name | Jonathan Lamar Benson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821467267 PECOS PAC ID: 6002125853 Enrollment ID: I20151019002336 |
| Provider Name | Amanda K Seales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518487610 PECOS PAC ID: 7113292590 Enrollment ID: I20171011001441 |
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