Provider Demographics
NPI:1043371883
Name:VESTER HEALTH CENTER LLC
Entity Type:Organization
Organization Name:VESTER HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:VESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-864-7887
Mailing Address - Street 1:140 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36862-2304
Mailing Address - Country:US
Mailing Address - Phone:334-864-7887
Mailing Address - Fax:334-864-0460
Practice Address - Street 1:140 1ST ST SE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:AL
Practice Address - Zip Code:36862-2304
Practice Address - Country:US
Practice Address - Phone:334-864-7887
Practice Address - Fax:334-864-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11415207Q00000X
AL10617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529800230Medicaid