NPIMap

Organization Active NPI

Spectracare Integrated Services LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dothan, AL
National Provider Identifier
1205385176
Registry record updated Oct 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SPECTRACARE INTEGRATED SERVICES LLC
Practice address
3542 Montgomery Hwy
Dothan, AL 36303-2165
Phone
(334) 712-2720
Fax
(334) 712-2727
NPI assigned
Oct 3, 2016
Organization subpart
Yes
Parent organization
SPECTRACARE HEALTH SYSTEMS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2016

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

Authorized official

Name
Mrs. Melissa Kirkland
Title
Chief Exectutive Officer
Phone
(334) 712-2720

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

3542 Montgomery Hwy
Dothan, AL 36303-2165

Mailing address

PO Box 1245
Dothan, AL 36302-1245
Phone (334) 712-2720

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161028001477 AL Part B Supplier - Clinic/Group Practice 8921386798 Receives reassigned benefits from 9 practitioners
Practice locations: Dothan, AL

National Provider Directory

National Provider Directory
Part of
Spectracare

Locations

1672 Columbia Hwy
Dothan, AL 36303
Phone (334) 712-2671

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/spectracare/r4/

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1475452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475452800000",
    "number": "1205385176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1245",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363021245",
            "telephone_number": "334-712-2720",
            "fax_number": "334-712-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3542 MONTGOMERY HWY",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363032165",
            "telephone_number": "334-712-2720",
            "fax_number": "334-712-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRACARE INTEGRATED SERVICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECTRACARE HEALTH SYSTEMS, INC.",
        "enumeration_date": "2016-10-03",
        "last_updated": "2016-10-03",
        "status": "A",
        "authorized_official_last_name": "KIRKLAND",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CHIEF EXECTUTIVE OFFICER",
        "authorized_official_telephone_number": "334-712-2720",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.