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Organization
HOUSTON COUNTY HEALTHCARE AUTHORITY
Active
Organization
HOUSTON COUNTY HEALTHCARE AUTHORITY
Active
Other names
Southeast Pain Management Center
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK MILLER CFO (CHIEF FINANCIAL OFFICER)
(334) 793-8087
Entity
Organization
Contact information
Practice address
1108 ROSS CLARK CIR, DOTHAN, AL 36301-3022
(334) 793-8087
(331) 793-8191
Mailing address
PO BOX 1928, DOTHAN, AL 36302-1928
(334) 793-8087
(334) 793-8191
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010057
BCBS OF ALABAMA
AL
05
—
HOS0001H
—
AL
Enumeration date
08/08/2006
Last updated
08/22/2020
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