NPIMap

Organization Active NPI

Family Health Clinic of Union Springs, Inc.

  • Rural Health Clinic/Center
  • Union Springs, AL
National Provider Identifier
1871701482
Registry record updated Oct 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAMILY HEALTH CLINIC OF UNION SPRINGS, INC.
Practice address
309 Prairie St North
Union Springs, AL 36089-1418
Phone
(334) 782-8824
Fax
(334) 408-4681
NPI assigned
May 18, 2007
Last updated
Oct 11, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2018

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

Authorized official

Name
Carol McMillan Holder, CRNPNPI 1184803066
Title
President/ Administrator
Phone
(334) 473-8795

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 26270 AL
Rural Health Clinic/Center 261QR1300X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X 1-031812 AL

Addresses

Primary practice location

309 Prairie St North
Union Springs, AL 36089-1418

Mailing address

309 Prairie St North
Union Springs, AL 36089-1418
Phone (334) 738-2146

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110114000730 AL Part A Provider - Rural Health Clinic 2163503475 Practice locations: Union Springs, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871701482. Details of each certification follow.

Rural health clinic certification: CCN 013959

Legal name
FAMILY HEALTH CLINIC OF UNION SPRINGS, INC.
Certification status
Terminated Voluntary: merger or closure, Oct 31, 2025
Provider type (POS)
Rural health clinic
Participating since
Jun 8, 2011
Last certification
Oct 25, 2017
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jun 12, 2007 in AL
Enrollment address
309 Prairie St N
Union Springs, AL 36089-1418

National Provider Directory

National Provider Directory

Locations

1765 Platt Pl
Montgomery, AL 36117

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Carol M Holder Individual 5% Or Greater Direct Ownership Interest Apr 30, 2008 100%
Corporate OfficerPresident Apr 30, 2008 100%
W-2 Managing EmployeePresident Apr 30, 2008 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539216000000",
    "number": "1871701482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 PRAIRIE ST NORTH",
            "city": "UNION SPRINGS",
            "state": "AL",
            "postal_code": "360891418",
            "telephone_number": "334-738-2146",
            "fax_number": "334-408-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 PRAIRIE ST NORTH",
            "city": "UNION SPRINGS",
            "state": "AL",
            "postal_code": "360891418",
            "telephone_number": "334-782-8824",
            "fax_number": "334-408-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CLINIC OF UNION SPRINGS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2018-10-11",
        "status": "A",
        "authorized_official_last_name": "HOLDER",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "MCMILLAN",
        "authorized_official_title_or_position": "PRESIDENT/ ADMINISTRATOR",
        "authorized_official_telephone_number": "334-473-8795",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "26270",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-031812",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union Springs, AL

Sources for this page

Verify at the official NPI Registry.