Provider Demographics
NPI:1073636650
Name:GREATER HUNTSVILLE FAMILY PRACTICE
Entity Type:Organization
Organization Name:GREATER HUNTSVILLE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-882-5060
Mailing Address - Street 1:2089 CECIL ASHBURN DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802
Mailing Address - Country:US
Mailing Address - Phone:256-882-5060
Mailing Address - Fax:256-882-9990
Practice Address - Street 1:2089 CECIL ASHBURN DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802
Practice Address - Country:US
Practice Address - Phone:256-882-5060
Practice Address - Fax:256-882-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H73094Medicare UPIN
0000038324Medicare ID - Type UnspecifiedRANDLE T MIDDLETON MD
F60057Medicare UPIN
E37235Medicare UPIN