Southeast Alabama Rural Health Associates
Organization Active NPI Federally Qualified Health Center (FQHC) · Abbeville, AL
NPI 1740580422 · NPPES record last updated Sep 12, 2022
Key facts
- NPI
- 1740580422
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES
- Practice address
- 615 Ozark Rd
Abbeville, AL 36310-2629 - Phone
- (334) 585-1171
- Fax
- (334) 585-1182
- NPI assigned
- Oct 27, 2010
- Organization subpart
- No
Authorized official
- Name
- Mrs. Pamylon Bowers
- Title
- Ceo
- Phone
- (334) 670-6726
Owners & managing parties with NPI records 7
Other NPIs on the same Medicare enrollment 11
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 9
Facilities with the same owner 4
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D2015694 | Abbeville Family Health Center | Certificate of waiver | Mar 31, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AL
Federally qualified health center certification: CCN 011975
- Legal name
- SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES
- Doing business as
- ABBEVILLE FAMILY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 12, 2011
- Last certification
- Jan 12, 2011
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 16, 1984 in AL
- Enrollment address
- 615 Ozark Road
Abbeville, AL 36310-2629
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Oveta Carey |
Other | Jun 22, 2021 | |
| Cynthia Pearson |
Other | Jan 1, 2011 | |
| Hank Strother |
Other | Jun 22, 2021 | |
| Regina Tolbert |
Other | Jun 22, 2021 | |
| Lisa Harris |
Other | Jun 22, 2021 | |
| Leticia Andrews |
Other | Jan 1, 2011 | |
| Southeast Alabama Rural Health Associates |
Operational/Managerial Control | Jan 1, 2011 | 100% |
| Joe Dalton |
Other | Jan 1, 2011 | |
| Pamylon Bowers |
Corporate Director |
Jun 22, 2021 | 100% |
| W-2 Managing Employee |
Jun 22, 2021 | 100% | |
| Jack Worthington |
Other | Jun 22, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
| O20110111000833 | AL | Part a Provider - Federally Qualified Health Center (FQHC) | 4880726850 | Practice locations: Abbeville, AL |
National Provider Directory
- Tax ID family
- Southeastwomens HLTH Ctr
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
615 Ozark Rd
Abbeville, AL 36310-2629
Mailing address
1414 Elba Hwy
Troy, AL 36079-6020
Phone (334) 670-6726
Other names
- Abbeville Family Health Center
Other providers in Abbeville, AL
- Martina Nicole Rogers
- Screamer Fire & Rescue
- Mandalyn P Smith
- Southeast Alabama Human Development Council
- Southeast Alabama Human Development Council
- Southern Eye Care Inc
- State of Alabama
- State of Alabama Department of Public Health
- Suprema Services, LLC.
- Robbie Treadwell
All providers in Abbeville, AL · Federally Qualified Health Center (FQHC) in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.