Basic Information
| Provider Information | |||||||||
| NPI: | 1700073996 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN RURAL HEALTH CARE CONSORTIUM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 PHYSICIANS DRIVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MUSCLE SHOALS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356610000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563813308 | ||||||||
| FaxNumber: | 2563811869 | ||||||||
| Practice Location | |||||||||
| Address1: | 2112 6TH AVENUE SE | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356010000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563401251 | ||||||||
| FaxNumber: | 2563530179 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2007 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | LOVETT | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2563813308 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1068168 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.