NPIMap

Organization Active NPI

Southeast Alabama Rural Health Associates

Doing business as Dothan Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Dothan, AL
National Provider Identifier
1194087593
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES
Doing business as
Dothan Family Health Center
Practice address
4300 W Main St Ste 300
Dothan, AL 36305-1313
Phone
(334) 446-0076
Fax
(334) 406-0203
NPI assigned
Jun 12, 2012
Last updated
Sep 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Pamylon Bowers, MPH
Title
Ceo
Phone
(334) 670-6726

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

4300 W Main St Ste 300
Dothan, AL 36305-1313

Mailing address

1414 Elba Hwy
Troy, AL 36079-6020
Phone (334) 670-6726

Other names 1

  • Dothan Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040526001591 AL Part B Supplier - Clinic/Group Practice 8123009057 Receives reassigned benefits from 32 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Troy, AL; Slocomb, AL; Newton, AL; Geneva, AL; Eufaula, AL; Enterprise, AL; Dothan, AL; Clayton, AL…
O20120823000937 AL Part A Provider - Federally Qualified Health Center (FQHC) 4789625948 Practice locations: Dothan, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194087593. Details of each certification follow.

Federally qualified health center certification: CCN 011808

Legal name
SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES
Doing business as
DOTHAN FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 24, 2012
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 16, 1984 in AL
Enrollment address
4300 W Main St
Ste 300
Dothan, AL 36305-1313

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2043066Dothan Family Health Center4300 West Main St Suite 300, Dothan, AL 36305AccreditationSep 12, 2027

National Provider Directory

National Provider Directory
Tax ID family
Southeastwomens HLTH Ctr10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4300 W Main St
Ste 300
Dothan, AL 36305
Phone (334) 446-0076

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Oveta Carey Individual Other Jun 22, 2024
Cynthia Pearson Individual Other Jul 1, 2012
Hank Strother Individual Other Jul 1, 2012
Regina Tolbert Individual Other Jun 22, 2021
Lisa Harris Individual Other Jun 22, 2021
Leticia Andrews Individual Other Jul 1, 2012
Southeast Alabama Rural Health Associates Organization, Troy, AL Non-profit Operational/Managerial Control Jul 1, 2012 100%
Joe Dalton Individual Other Jul 1, 2012
Pamylon Bowers Individual Corporate DirectorCeo Jun 22, 2021 100%
W-2 Managing EmployeeCeo Jun 22, 2021 100%
Jack Worthington Individual Other Jun 22, 2021

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662940800000",
    "number": "1194087593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 ELBA HWY",
            "city": "TROY",
            "state": "AL",
            "postal_code": "360796020",
            "telephone_number": "334-670-6726",
            "fax_number": "334-670-6731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 W MAIN ST STE 300",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051313",
            "telephone_number": "334-446-0076",
            "fax_number": "334-406-0203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A",
        "authorized_official_last_name": "BOWERS",
        "authorized_official_first_name": "PAMYLON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-670-6726",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dothan Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dothan Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.