Provider Demographics
NPI:1093349920
Name:BACK TO BASICS HEALTHCARE LLC
Entity Type:Organization
Organization Name:BACK TO BASICS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-302-3773
Mailing Address - Street 1:5730 US HIGHWAY 431
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-0234
Mailing Address - Country:US
Mailing Address - Phone:256-907-9700
Mailing Address - Fax:256-907-9724
Practice Address - Street 1:5730 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-0234
Practice Address - Country:US
Practice Address - Phone:256-907-9700
Practice Address - Fax:256-907-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-29
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1245695667OtherNPI
AL1942830716OtherNPI
AL1588103295OtherNPI
AL1801102959OtherNPI