Provider Demographics
NPI:1154497105
Name:FAMILY PRACTICE ASSOCIATES OF MONTROSE, PA
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF MONTROSE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-928-1191
Mailing Address - Street 1:770 MIDDLE ST STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1766
Mailing Address - Country:US
Mailing Address - Phone:251-928-1191
Mailing Address - Fax:251-928-4529
Practice Address - Street 1:770 MIDDLE ST STE B
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1766
Practice Address - Country:US
Practice Address - Phone:251-928-1191
Practice Address - Fax:251-928-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACB8304OtherRAILROAD MEDICARE
ALC72568Medicare UPIN
AL000026573Medicare ID - Type Unspecified
AL051553942Medicare ID - Type Unspecified
AL000018411Medicare ID - Type Unspecified
ALF97471Medicare UPIN
AL000004068Medicare ID - Type Unspecified
GACB8304OtherRAILROAD MEDICARE
ALH56348Medicare UPIN