Organization
RAYNARD FABIANKE, MEDICAL CLINIC OF RED BAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA COPELAND (BILLING MANAGER)
(256) 532-1888
Entity
Organization
Contact information
Practice address
209 HOSPITAL RD, RED BAY, AL 35582-3858
(256) 356-9511
(256) 356-9339
Mailing address
PO BOX 429, RED BAY, AL 35582-0429
(256) 356-9511
(256) 356-9339
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CM2749
MEDICARE RAILROAD
—
Enumeration date
10/23/2006
Last updated
09/30/2013
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