SOUTHEAST ALABAMA MEDICAL CENTER (NPI# 1366626285) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366626285 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST ALABAMA MEDICAL CENTER |
| Other Organization Name | SAMC |
| Practice Address |
1108 Ross Clark Cir Attn: Physical Therapy Dept Dothan AL 36301-3022 |
| Mailing Address |
1108 Ross Clark Circle Attn: Physical Therapy Dept Dothan AL 36301 |
| Practice Telephone | 3347123726 |
| Practice Fax Number | 3347123553 |
| Mailing Telephone | 3347123726 |
| Mailing Fax Number | 3347123553 |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2007-12-27 |
| Authorized Official Name | MRS. CECILIA LAND (DIRECTOR OF REHAB) |
| Authorized Official Telephone | 3347123726 |
| Authorized Official Credential | PT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | PTH3336 | AL | Hospitals |
| Other Name | Type Code |
|---|---|
| SAMC | Other Name - Individual/Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SOUTHEAST ALABAMA MEDICAL CENTER | 1108 Ross Clark Cir, Dothan, AL 36301-3022 |
| System for Award Management (SAM) Entities | SOUTHEAST ALABAMA MEDICAL CENTER FOUNDATION, INC, THE | 1922 Fairview Ave, Dothan, AL 36301-3008 |
| Street Address |
1108 ROSS CLARK CIR ATTN: PHYSICAL THERAPY DEPT |
| City | DOTHAN |
| State | AL |
| Zip Code | 36301-3022 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679576268 | Judith L Bosse | Nurse Practitioner | 1108 Ross Clark Cir, Hospitalist Office, Dothan, AL 36301-3022 | 2005-05-27 |
| 1811597073 | Michael Brian Pierce | Registered Nurse | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2020-10-27 |
| 1659990901 | Robert Dale Garrett | Nurse Anesthetist, Certified Registered | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2020-04-15 |
| 1861028607 | Richard Henry Jester | Physician Assistant | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2020-03-12 |
| 1467017335 | Keaton Peak | Registered Nurse | 1108 Ross Clark Cir, Dothan, AL 36301 | 2019-05-07 |
| 1396214060 | Shalita Clark | Psychiatry & Neurology | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2018-11-24 |
| 1619452760 | Drew Mckenzie Hubbard | Registered Nurse | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2018-09-25 |
| 1609359926 | Amber Salmon | Dietitian, Registered | 1108 Ross Clark Cir, Dothan, AL 36301-3024 | 2018-09-12 |
| 1255825832 | Shannon Louette Skaug | Nurse Practitioner | 1108 Ross Clark Cir, Dothan, AL 36301-3024 | 2018-06-18 |
| 1225529712 | Vyshnavi Kone | Student in an Organized Health Care Education/Training Program | 1108 Ross Clark Cir, Dothan, AL 36301 | 2018-05-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043862931 | Pharmacy Center South LLC | Pharmacy | 2826 Ross Clark Circle, Suite 103, Dothan, AL 36301 | 2019-07-11 |
| 1851879167 | Attallah Cotton | Social Worker | 101 Eastridge Dr, Dothan, AL 36301 | 2018-07-31 |
| 1225522709 | Nichole Johnson Prestwood | Nurse Practitioner | 2431 W Main St Ste 501, Dothan, AL 36301 | 2018-06-19 |
| 1750805818 | Kimberly Danielle Austin | Speech-Language Pathologist | 404 Darlington Cir, Dothan, AL 36301 | 2017-07-31 |
| 1952794885 | Lori P. Granberry | Pharmacist | 2131 Ross Clark Circle, Dothan, AL 36301 | 2015-03-17 |
| 1801286059 | Robert Cody Russell | Nurse Practitioner | 1118 Ross Clark Circle, Suite 100, Dothan, AL 36301 | 2015-01-27 |
| 1720407646 | Michael Kreger | Anesthesiology | 1118 Ross Clark Cir Ste 700, Dothan, AL 36301 | 2014-04-08 |
| 1063851277 | Carlos Stanford Clark II | Family Medicine | 201 Doctors Drive, Dothan, AL 36301 | 2013-06-20 |
| 1639489313 | Robert Fort Hambaugh Jr. | Specialist | 712 Woodland Drive, Dothan, AL 36301 | 2010-10-15 |
| 1588894976 | Atwill Lamar Miller Jr. | Urology | 1908 Fairview Avenue, Dothan, AL 36301 | 2009-07-20 |
| Find all providers in zip 36301 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164403861 | Houston County Healthcare Authority | General Acute Care Hospital | 1108 Ross Clark Circle, Dothan, AL 36301-3022 | 2005-11-09 |
| 1295161396 | Managed Health Care Administration, Inc | General Acute Care Hospital | 1108 Ross Clark Cir, Dothan, AL 36301-3022 | 2013-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609311000 | Mobile Infirmary Association | General Acute Care Hospital | 1721 Spring Hill Ave, Mobile, AL 36604-1402 | 2016-12-21 |
| 1518349448 | Baptist Health | General Acute Care Hospital | 109 Bowen Bnd, Wetumpka, AL 36093-2592 | 2015-06-27 |
| 1497162085 | Belinda Beaver | General Acute Care Hospital | 25627 Lakeland Dr, Loxley, AL 36551-7453 | 2014-07-16 |
| 1982048476 | University of Alabama At Birmingham | General Acute Care Hospital | 1700 6th Ave South, Uab, Birmingham, AL 35249 | 2013-04-26 |
| 1346684008 | University of Alabama At Birmingham Hospital | General Acute Care Hospital | Fot 1034 1530 3rd Ave S, Birmingham, AL 35294-3410 | 2013-04-24 |
| 1528311271 | Univ. of Alabama Birmingham Hospital | General Acute Care Hospital | 510 20th St. So (fot-1164), Uab, Plastic Surgery, Birmingham, AL 35294-3411 | 2012-10-18 |
| 1588928618 | Princeton Baptist Medical Center | General Acute Care Hospital | 187 Lorrin Ln, Sterrett, AL 35147-9528 | 2012-07-04 |
| 1043585680 | Uahsf | General Acute Care Hospital | 914 Medical Education Building 1813 6th Ave S, Birmingham, AL 35294-0001 | 2012-03-15 |
| 1598052219 | University of Alabama At Birmingham Hospital | General Acute Care Hospital | 510 20th St S # Fot1020, Birmingham, AL 35233-2028 | 2011-07-01 |
| 1023311644 | University of Alabama At Birmingham | General Acute Care Hospital | Fot 930, 1530 3rd Ave S, Birmingham, AL 35294-0019 | 2010-12-21 |
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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.