Organization Active NPI

Wiregrass Mental Health Board Inc

Doing business as SpectraCare

Adolescent and Children Mental Health Clinic/Center
Dothan, AL

National Provider Identifier

1568638534

Registry record updated Apr 30, 2008

On this page

Key facts
NPPES NPI Registry
National Provider Directory
NPI Registry JSON
Other providers in Dothan, AL
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name: WIREGRASS MENTAL HEALTH BOARD INC
Doing business as: SpectraCare
Practice address: 134 Prevatt Rd
Dothan, AL 36301-5427
Phone: (334) 794-0731
NPI assigned: Apr 30, 2008
Last updated: Apr 30, 2008By the provider in NPPES
Organization subpart: No

NPPES NPI Registry

Updated by the provider on Apr 30, 2008

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

Authorized official

Name: Mrs. Melissa Kirkland
Title: Executive Director
Phone: (334) 712-2720

Specialties & licenses 2

Specialty (taxonomy)	Code	License	State	Primary
Mental Health Clinic/Center (Including Community Mental Health Center)	261QM0801X
Adolescent and Children Mental Health Clinic/Center	261QM0855X			Primary

Addresses

Primary practice location

134 Prevatt Rd
Dothan, AL 36301-5427

Mailing address

PO Box 1245
2694 South Park Ave.
Dothan, AL 36302-1245
Phone (334) 712-2720

Other identifiers 19

Identifier	Type	State	Issuer
000008817	Other	AL	MEDICARE
590000010	Medicaid	AL
331600587	Medicaid	AL
059726100	Medicaid	FL
20427	Other	AL	MEDICARESECONDARY
331000069	Medicaid	AL
330034010	Medicaid	AL
331000067	Medicaid	AL
331000467	Medicaid	AL
51003550	Other	AL	COMMERCIAL INS.
33000067	Medicaid	AL
33034010	Medicaid	AL
591500003	Medicaid	AL
14609	Other	AL	MEDICARE SECONDARY
330000010	Medicaid	AL
51043902	Other	AL	BLUE CROSS BLUE SHIELD
591600003	Medicaid	AL
14635	Other	AL	MEDICARE SECONDARY
331600592	Medicaid	AL

Other names 1

SpectraCare Doing business as

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1568638534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1245",
            "address_2": "2694 SOUTH PARK AVE.",
            "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": "134 PREVATT RD",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363015427",
            "telephone_number": "334-794-0731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIREGRASS MENTAL HEALTH BOARD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "KIRKLAND",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "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": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "000008817",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "590000010",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331600587",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "059726100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARESECONDARY",
            "identifier": "20427",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331000069",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330034010",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331000067",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331000467",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL INS.",
            "identifier": "51003550",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33000067",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33034010",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "591500003",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE SECONDARY",
            "identifier": "14609",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330000010",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51043902",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "591600003",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE SECONDARY",
            "identifier": "14635",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331600592",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SpectraCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.