Basic Information
| Provider Information | |||||||||
| NPI: | 1386912723 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH ALABAMA MEDICAL CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8159 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366890159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514145810 | ||||||||
| FaxNumber: | 2514145809 | ||||||||
| Practice Location | |||||||||
| Address1: | 10075 GRAND BAY WILMER RD S | ||||||||
| Address2: | |||||||||
| City: | GRAND BAY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365415003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2518651852 | ||||||||
| FaxNumber: | 2518651854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2011 | ||||||||
| LastUpdateDate: | 12/28/2011 | ||||||||
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| AuthorizedOfficialLastName: | STOKES | ||||||||
| AuthorizedOfficialFirstName: | LLOYD | ||||||||
| AuthorizedOfficialMiddleName: | SEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2518651852 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CFNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.