Basic Information
| Provider Information | |||||||||
| NPI: | 1013399625 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHEAST ALABAMA REGIONAL HEALTHCARE AUTHORITY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EUFAULA FAMILY PRACTICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 W WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | EUFAULA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360271822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346887128 | ||||||||
| FaxNumber: | 3346887127 | ||||||||
| Practice Location | |||||||||
| Address1: | 617B E BROAD ST | ||||||||
| Address2: | |||||||||
| City: | EUFAULA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360271710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346887000 | ||||||||
| FaxNumber: | 3346887127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2015 | ||||||||
| LastUpdateDate: | 08/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | WALTERS | ||||||||
| AuthorizedOfficialFirstName: | LYNDA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3346887128 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.