Provider Demographics
NPI:1093881468
Name:MEDICAL ASSOCIATES OF THE SHOALS, P.C.
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF THE SHOALS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:VACIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-383-4447
Mailing Address - Street 1:1120 S JACKSON HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-5773
Mailing Address - Country:US
Mailing Address - Phone:256-383-4447
Mailing Address - Fax:256-381-7999
Practice Address - Street 1:1120 S JACKSON HWY STE 300
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5773
Practice Address - Country:US
Practice Address - Phone:256-383-4447
Practice Address - Fax:256-381-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG766Medicare PIN