Basic Information
| Provider Information | |||||||||
| NPI: | 1275184848 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RMCCA CLINIC B, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 N COLLEGE ST | ||||||||
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| City: | GREENVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360372025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343822681 | ||||||||
| FaxNumber: | 3343839884 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 MEDICAL ARTS CT STE 3 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360373872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343822681 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2019 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | WILCOX | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3343832423 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI | ||||||||
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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.