NPIMap

Organization Active NPI

Family Health Care Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Town Creek, AL
National Provider Identifier
1508099151
Registry record updated Jul 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH CARE CLINIC, INC.
Practice address
1841 Alabama Highway 20
Town Creek, AL 35646
Phone
(601) 825-7280
Fax
(601) 825-8130
NPI assigned
Aug 31, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2018

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

Authorized official

Name
Karina Marie Clayton
Title
Chief Financial Officer
Phone
(601) 825-7280

Specialties & licenses 1

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

Addresses

Primary practice location

1841 Alabama Highway 20
Town Creek, AL 35646

Mailing address

PO Box 24116
Jackson, MS 39225-4116
Phone (601) 825-7280

Other identifiers 1

IdentifierTypeStateIssuer
116432MedicaidAL

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100318000697 AL Part A Provider - Federally Qualified Health Center (FQHC) 5395656946 Practice locations: Town Creek, AL
O20100628001034 AL Part B Supplier - Clinic/Group Practice 5395656946 Receives reassigned benefits from 22 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Russellville, AL; Town Creek, AL; Rogersville, AL; Muscle Shoals, AL; Florence, AL; Decatur, AL

Federally qualified health center certification: CCN 011966

Legal name
FAMILY HEALTH CARE CLINIC INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 19, 2010
Last certification
Mar 19, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1996 in MS
Enrollment address
1841 Al Highway 20
Town Creek, AL 35672-2500

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Family Health Care Clin36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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

View all 35

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
Margaret a Gray Individual W-2 Managing Employee Aug 5, 2009
George a Spann Individual Corporate Director Jul 21, 2009
Charles Hatten Individual Corporate Director Aug 28, 2009
Michael Howard Individual Corporate Director Jul 21, 2009
Linda Taylor Individual Corporate Director Jul 21, 2009
Helen Johnson Individual Corporate Director Jul 21, 2009
Louise Patterson Individual Corporate Director Aug 28, 2009
Family Health Care Clinic Inc Organization, Jackson, MS Non-profit Operational/Managerial Control Aug 1, 2009
Carolyn Hartzog Individual Corporate Director Aug 28, 2009
Cindy Bryan Individual Corporate Director Aug 28, 2009
Eddie Thames Individual Corporate Director Aug 28, 2009

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Family Health Care Clinic IncRussellville, AL, CCN 011965 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncMuscle Shoals, AL, CCN 011970 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncDecatur, AL, CCN 011967 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncFlorence, AL, CCN 011969 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncRogersville, AL, CCN 011971 Federally qualified health center Operational/Managerial Control Aug 1, 2009

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1251676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530576000000",
    "number": "1508099151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24116",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392254116",
            "telephone_number": "601-825-7280",
            "fax_number": "601-825-8130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1841 ALABAMA HIGHWAY 20",
            "city": "TOWN CREEK",
            "state": "AL",
            "postal_code": "35646",
            "telephone_number": "601-825-7280",
            "fax_number": "601-825-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CARE CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-31",
        "last_updated": "2018-07-03",
        "status": "A",
        "authorized_official_last_name": "CLAYTON",
        "authorized_official_first_name": "KARINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "601-825-7280"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116432",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Town Creek, AL

Sources for this page

Verify at the official NPI Registry.