PICKENS COUNTY PRIMARY CARE, P.C (NPI# 1063988806) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063988806 |
| Entity Type | Organization |
| Organization Name | PICKENS COUNTY PRIMARY CARE, P.C |
| Practice Address |
630 4th St Nw Gordo AL 35466 |
| Mailing Address |
108 4th Ave Sw Ste A Reform AL 35481-8018 |
| Practice Telephone | 2053756251 |
| Practice Fax Number | 2053759064 |
| Mailing Telephone | 2053756251 |
| Mailing Fax Number | 2053759064 |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2020-02-19 |
| Authorized Official Name | JULIA L BOOTHE (OWNER) |
| Authorized Official Telephone | 2057926701 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | PICKENS COUNTY PRIMARY CARE, P.C |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Gordo SMART | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508332446 | Pickens County Primary Care, P.c | Family Medicine | 815 7th Ave Sw, Reform, AL 35481 | 2018-10-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PICKENS COUNTY PRIMARY CARE, P.C. | 108 4th Avenue Sw Ste A, Reform, AL 35481-8018 |
| Street Address |
630 4TH ST NW |
| City | GORDO |
| State | AL |
| Zip Code | 35466 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194989749 | Timothy Luke Hagler | Dentist | 27290 Hwy 86, Gordo, AL 35466 | 2008-07-14 |
| 1649339797 | Alabama Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 536 Hudson Drive, Gordo, AL 35466 | 2006-12-06 |
| 1114992070 | John E Brandon | Family Medicine | 27340 Highway 86, Gordo, AL 35466 | 2006-02-22 |
| 1467506469 | Pickens County Medical Center | Clinic/Center | 27340 Hwy 86, Gordo, AL 35466 | 2007-01-23 |
| 1598013187 | Encore Rehabilitation, Inc. | Clinic/Center | 219 Industrial Park St, Gordo, AL 35466-2068 | 2012-08-29 |
| 1386284495 | Ellynn Joann Rolett | Specialist/Technologist | 219 Industrial Park St, Gordo, AL 35466-2068 | 2020-01-07 |
| 1770974735 | Brooke Owens | Physical Therapist | 219 Industrial Park St, Gordo, AL 35466-2068 | 2015-02-12 |
| 1699777219 | Medrental Inc | Durable Medical Equipment & Medical Supplies | 25660 Highway 82, Gordo, AL 35466-2261 | 2005-08-12 |
| 1225249493 | Na'toyia Shanay Stewart | Dental Assistant | 327 11th St Se, Gordo, AL 35466-2413 | 2007-05-26 |
| 1669810891 | Mills Pills LLC - Gordo | Pharmacy | 515 Hudson Dr, Gordo, AL 35466-2432 | 2013-06-10 |
| Find all providers in zip 35466 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982205753 | Pickens County Primary Care PC | Clinic/Center | 99 Commerce Avenue, Carrollton, AL 35447 | 2020-11-06 |
| 1952952541 | Pediatric Associates of Alexander City PC | Clinic/Center | 21 Coosa County Road 50, Kellyton, AL 35089-1900 | 2019-09-25 |
| 1205309044 | Boa Vida Hospital of Aberdeen, Ms LLC | Clinic/Center | 184 William E Hill Drive Ste C, Carrollton, AL 35447 | 2019-01-04 |
| 1487123915 | Physicians Care of Camden LLC | Clinic/Center | 24b Camden Byp, Camden, AL 36726-1770 | 2018-11-14 |
| 1336634666 | Central Pediatrics of Somerville LLC | Clinic/Center | 3609 Highway 67 S, Somerville, AL 35670 | 2018-06-28 |
| 1578060349 | Ivy Creek of Elmore, LLC | Clinic/Center | 4412 Hogan Rd, Deatsville, AL 36022-3400 | 2018-04-09 |
| 1568915106 | Physicians Care of Grove Hill LLC | Clinic/Center | 127 Clark St Ste C&d, Grove Hill, AL 36451-3050 | 2016-08-01 |
| 1205294428 | Red Bay Hospital Outpatient Clinics LLC | Clinic/Center | 14490 County Line Road, Suite A, Muscle Shoals, AL 35661 | 2016-02-02 |
| 1972985968 | Athens Limestone Pediatric Center LLC | Clinic/Center | 101 Fitness Way Ste 2100, Athens, AL 35611-2494 | 2015-06-25 |
| 1396125258 | D W Mcmillan Memorial Hospital | Clinic/Center | 1674 Cleveland Ave, Castleberry, AL 36432 | 2015-06-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.