Organization
SOUTHERN RURAL HEALTH CARE CONSORTIUM, INC.
Active
Other names
Decatur Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY L HALL (EXECUTIVE DIRECTOR)
(256) 332-1631
Entity
Organization
Contact information
Practice address
1304 13TH AVENUE S.E., SUITE F, DECATUR, AL 35601
(256) 332-1631
(256) 332-4600
Mailing address
PO BOX 970, RUSSELLVILLE, AL 35653-0970
(256) 332-1631
(256) 332-4600
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-1902
MEDICARE #
AL
01
—
01200280
BLUE CROSS BLUE SHIELD AL
—
05
—
630005001
—
AL
Enumeration date
11/15/2006
Last updated
10/07/2010
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