Organization
WIREGRASS MENTAL HEALTH BOARD INC
Active
Other names
SpectraCare
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELISSA KIRKLAND (EXECUTIVE DIRECTOR)
(334) 712-2720
Entity
Organization
Contact information
Practice address
134 PREVATT RD, DOTHAN, AL 36301-5427
(334) 794-0731
Mailing address
PO BOX 1245, 2694 SOUTH PARK AVE., DOTHAN, AL 36302-1245
(334) 712-2720
(334) 712-2727
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000008817
MEDICARE
AL
05
—
059726100
—
FL
01
—
14609
MEDICARE SECONDARY
AL
01
—
14635
MEDICARE SECONDARY
AL
01
—
20427
MEDICARESECONDARY
AL
05
—
330000010
—
AL
05
—
33000067
—
AL
05
—
330034010
—
AL
05
—
33034010
—
AL
05
—
331000067
—
AL
05
—
331000069
—
AL
05
—
331000467
—
AL
05
—
331600587
—
AL
05
—
331600592
—
AL
01
—
51003550
COMMERCIAL INS.
AL
01
—
51043902
BLUE CROSS BLUE SHIELD
AL
05
—
590000010
—
AL
05
—
591500003
—
AL
05
—
591600003
—
AL
Enumeration date
04/30/2008
Last updated
04/30/2008
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