Organization
HOUSTON COUNTY HEALTHCARE AUTHORITY
Active
Organization
HOUSTON COUNTY HEALTHCARE AUTHORITY
Active
Parent organization
HOUSTON COUNTY HEALTHCARE AUTHORITY
Other names
SAMC Specialty Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
HOUSTON COUNTY HEALTHCARE AUTHORITY
Authorized official
DEBORAH S WOODHAM CPC (CONTRACT MANAGER)
(334) 793-8087
Entity
Organization
Contact information
Practice address
4284 KELSON AVE, MARIANNA, FL 32446-2948
(334) 793-8804
(334) 699-4473
Mailing address
PO BOX 1928, DOTHAN, AL 36302-1928
(334) 793-8087
(334) 793-8191
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207T00000X
Neurological Surgery Physician
Primary
OS12208
FL
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39888B
BLUE CROSS BLUE SHIELD
FL
05
—
660005100
—
FL
01
—
DD1649
RAILROAD MEDICARE
—
Enumeration date
01/09/2007
Last updated
03/08/2016
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