Provider Demographics
NPI:1871701482
Name:FAMILY HEALTH CLINIC OF UNION SPRINGS, INC.
Entity type:Organization
Organization Name:FAMILY HEALTH CLINIC OF UNION SPRINGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:MCMILLAN
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:334-473-8795
Mailing Address - Street 1:309 PRAIRIE ST NORTH
Mailing Address - Street 2:
Mailing Address - City:UNION SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:36089-1418
Mailing Address - Country:US
Mailing Address - Phone:334-738-2146
Mailing Address - Fax:334-408-4681
Practice Address - Street 1:309 PRAIRIE ST NORTH
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:36089-1418
Practice Address - Country:US
Practice Address - Phone:334-782-8824
Practice Address - Fax:334-408-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26270207Q00000X
261QR1300X
AL1-031812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL138855Medicaid
AL529932739Medicaid
Z08969Medicare UPIN