NPIMap

Organization Active NPI

Wiregrass Behavioral Group LLC

  • Multi-Specialty Clinic/Center
  • Dothan, AL
National Provider Identifier
1821609389
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
WIREGRASS BEHAVIORAL GROUP LLC
Practice address
256 Honeysuckle Rd Ste 12
Dothan, AL 36305-1168
Phone
(334) 792-6736
Fax
(334) 792-6737
NPI assigned
Aug 10, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

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

Authorized official

Name
Miss Phillip Johnson
Title
President
Phone
(334) 792-6736

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

256 Honeysuckle Rd Ste 12
Dothan, AL 36305-1168

Mailing address

256 Honeysuckle Rd Ste 12
Dothan, AL 36305-1168
Phone (334) 792-6736

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200917000368 AL Part B Supplier - Clinic/Group Practice 6103244504 Receives reassigned benefits from 5 practitioners
Practice locations: Dothan, AL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1597017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597276800000",
    "number": "1821609389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "256 HONEYSUCKLE RD STE 12",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051168",
            "telephone_number": "334-792-6736",
            "fax_number": "334-792-6737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 HONEYSUCKLE RD STE 12",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051168",
            "telephone_number": "334-792-6736",
            "fax_number": "334-792-6737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIREGRASS BEHAVIORAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-10",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "334-792-6736",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "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 Aug 13, 2020; 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.