Organization
CLEBURNE MEDICAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IGOR BIDIKOV M.D. (PRESIDENT AND OWNER)
(256) 463-7454
Entity
Organization
Contact information
Practice address
40 GILES ST, HEFLIN, AL 36264-1738
(256) 463-7454
(256) 463-7725
Mailing address
40 GILES ST, HEFLIN, AL 36264-1738
(256) 463-7454
(256) 463-7725
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DB4844
RAILROAD GROUP NUMBER
AL
01
—
P00108638
RAILROAD MEDICARE PROV ID
AL
Enumeration date
02/22/2006
Last updated
02/06/2008
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