1427760289 NPI number — UNBROKEN CLINIC LLC

Table of content: (NPI 1427760289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427760289 NPI number — UNBROKEN CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNBROKEN CLINIC LLC
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:
Provider Other Organization Name Type Code:
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:
1427760289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 MISTY FOREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHENIX CITY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36869-3492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-460-2361
Provider Business Mailing Address Fax Number:
706-287-1124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
823 VETERANS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31901-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-992-6000
Provider Business Practice Location Address Fax Number:
706-287-1124
Provider Enumeration Date:
12/22/2022

Additional Information

Authorized Official

Authorized Official Last Name:
SEXTON
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
PLAYER
Authorized Official Title or Position:
OWNER/EMPLOYEE
Authorized Official Telephone Number:
334-545-7136

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1376784587 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1376269910 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com