1154362655 NPI number — COMPLETE FAMILY MEDICINE

Table of content: (NPI 1154362655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154362655 NPI number — COMPLETE FAMILY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE FAMILY MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALABAMA SPECIALITY CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154362655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 638
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CULLMAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35056-0638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-737-9416
Provider Business Mailing Address Fax Number:
256-736-5684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1908 CHEROKEE AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULLMAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35055-5502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-737-9416
Provider Business Practice Location Address Fax Number:
256-736-5684
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCIAL DIRECTOR
Authorized Official Telephone Number:
256-737-9416

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 305R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051507133 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1366514945 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1588603807 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 080148738 . This is a "RRMC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1235175886 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1629093638 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009912575 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 438170475 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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