Basic Information
| Provider Information | |||||||||
| NPI: | 1699093690 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHEAST ALABAMA REGIONAL HEALTH | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MCB CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 W WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | EUFAULA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360271822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346887020 | ||||||||
| FaxNumber: | 3346887022 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 W WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | EUFAULA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360271822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346887020 | ||||||||
| FaxNumber: | 3346887022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2010 | ||||||||
| LastUpdateDate: | 08/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | NORTON | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3346887272 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD30111 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.