| Montgomery Primary Care | |
|
3060 Mobile Hwy Montgomery AL 36108-4027 | |
| (334) 293-6670 | |
| (334) 293-6676 |
| Full Name | Montgomery Primary Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 3060 Mobile Hwy, 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 |
|---|---|
| Montgomery Primary Care Po Box 70365 Montgomery AL 36107-0365 Ph: (334) 263-2301 | Montgomery Primary Care 3060 Mobile Hwy Montgomery AL 36108-4027 Ph: (334) 293-6670 |
| NPI Number | 1528082336 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 11/29/2023 |
| Certification Date | 11/29/2023 |
| Medicare PECOS PAC ID | 1557324811 |
|---|---|
| Medicare Enrollment ID | O20100707000180 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528082336 | NPI | - | NPPES |
| 630002009 | Medicaid | AL | |
| 01D0967315 | Other | AL | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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