NPIMap

Organization Active NPI

Southeast Alabama Rural Health Associates

Doing business as Andalusia Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Andalusia, AL
National Provider Identifier
1417753237
Registry record updated Feb 21, 2025
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
Andalusia Family Health Center
Practice address
1021 Sanford Rd
Andalusia, AL 36420-4156
Phone
(334) 582-1130
Fax
(334) 582-1131
NPI assigned
Feb 21, 2025
Last updated
Feb 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2025

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

Authorized official

Name
Pamylon Gatlin Bowers
Title
Ceo
Phone
(334) 670-6726

Specialties & licenses 1

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

Addresses

Primary practice location

1021 Sanford Rd
Andalusia, AL 36420-4156

Mailing address

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

Other names 1

  • Andalusia 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…
O20250610003260 AL Part A Provider - Federally Qualified Health Center (FQHC) 8123009057 Practice locations: Andalusia, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417753237. Details of each certification follow.

Federally qualified health center certification: CCN 011123

Legal name
SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES
Doing business as
ANDALUSIA FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 4, 2025
Last certification
Jun 4, 2025
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
1021 Sanford Rd
Andalusia, AL 36420-4156

Other NPIs with the same Medicare PAC ID 6

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
01D2320469Andalusia Family Health Center1021 Sanford Road, Andalusia, AL 36420Certificate of waiverMar 17, 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

1021 Sanford Rd
Andalusia, AL 36420
Phone (334) 582-1130

430 W Lawrence Harris Hwy
Slocomb, AL 36375
Phone (334) 886-3023

Ownership & related parties

All disclosed owners & managing parties 11

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 Corporate OfficerBoard Member Feb 4, 2025 100%
Cynthia Pearson Individual Corporate OfficerBoard Member Feb 4, 2025 100%
Hank Strother Individual Corporate OfficerBoard Member Feb 4, 2025 100%
Dannie Walker Individual Corporate OfficerBoard Member Feb 4, 2025 100%
Regina Tolbert Individual Corporate OfficerBoard Member Feb 4, 2025 100%
Ray Marler Individual Corporate OfficerBoard Member Feb 4, 2025 100%
Lisa Harris Individual Corporate OfficerBoard Member Feb 4, 2025 100%
Leticia Andrews Individual Corporate OfficerBoard Member Feb 4, 2025 100%
Joe Dalton Individual Corporate OfficerBoard Member Feb 4, 2025 100%
Pamylon Bowers Individual Corporate OfficerCeo Feb 4, 2025 100%
W-2 Managing EmployeeCeo Feb 4, 2025 100%
Operational/Managerial ControlCeo Feb 4, 2025 100%
Jack Worthington Individual Corporate OfficerBoard Member Feb 4, 2025 100%

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Slocomb Family Health CenterSlocomb, AL, CCN 011955 Federally qualified health center Operational/Managerial Control (100%) Jul 25, 2011
Clayton Family Health CenterClayton, AL, CCN 011868 Federally qualified health center Operational/Managerial Control Sep 17, 2025
Abbeville Family Health CenterAbbeville, AL, CCN 011975 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2011
Dothan Family Health CenterDothan, AL, CCN 011808 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2012
Geneva Family Health CenterGeneva, AL, CCN 011088 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2021

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1740096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740096000000",
    "number": "1417753237",
    "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": "1021 SANFORD RD",
            "city": "ANDALUSIA",
            "state": "AL",
            "postal_code": "364204156",
            "telephone_number": "334-582-1130",
            "fax_number": "334-582-1131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-21",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-18",
        "status": "A",
        "authorized_official_last_name": "BOWERS",
        "authorized_official_first_name": "PAMYLON",
        "authorized_official_middle_name": "GATLIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-670-6726"
    },
    "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": "Andalusia Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Andalusia, AL

Sources for this page

Verify at the official NPI Registry.