Dale Medical Center
Organization Active NPI Family Medicine Physician · Ozark, AL
NPI 1003264136 · NPPES record last updated Apr 11, 2018
Key facts
- NPI
- 1003264136
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- DALE MEDICAL CENTER
- Practice address
- 633 South Union Ave
Ozark, AL 36360 - Phone
- (334) 774-7572
- Fax
- (334) 774-6237
- NPI assigned
- May 31, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- DALE MEDICAL CENTER
Authorized official
- Name
- Mr. Vernon L. Johnson
- Title
- Ceo
- Phone
- (334) 774-2601
Other NPIs on the same Medicare enrollment 14
Corporate family (same tax ID) 12
Practitioners 3
-
Margaret J. Hughes, CRNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D0953785 | South Union Family Medicine | Certificate of waiver | Nov 9, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031107000202 | AL | Part B Supplier - Clinic/Group Practice | 3476466327 |
Receives reassigned benefits from 47 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ozark, AL |
National Provider Directory
- Tax ID family
- United Probill
- Part of
- United Probill
Locations
633 S Union Ave
Ozark, AL 36360
Phone (334) 774-7572
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/dale-309b724a
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
633 South Union Ave
Ozark, AL 36360
Mailing address
PO Box 863
Ozark, AL 36361-0863
Phone (334) 443-1211
Other names
- South Union Family Medicine
Other providers in Ozark, AL
- Dale County Health Dept Prev Health Ed
- Dale County Health Dept Pri Care
- Dale County Health Dept STD
- Dale County Health Dept VFC Immun
- Dale County Mental Retardation Board
- Dale Medical Center
- Dale Medical Center
- Dale Medical Center
- Dale Medical Center
- Dale Medical Center
All providers in Ozark, AL · Family Medicine Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.