Provider Demographics
NPI:1164679676
Name:RAINSVILLE FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:RAINSVILLE FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-845-1401
Mailing Address - Street 1:421 MEDICAL CENTER DR SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3421
Mailing Address - Country:US
Mailing Address - Phone:256-845-1401
Mailing Address - Fax:256-845-1402
Practice Address - Street 1:421 MEDICAL CENTER DR SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3421
Practice Address - Country:US
Practice Address - Phone:256-845-1401
Practice Address - Fax:256-845-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4221491OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
AL51107803OtherBCBS OF AL
P00664321OtherRR MEDICARE
AL142769Medicaid
510G700383Medicare PIN
TN4221491OtherBLUE CROSS BLUE SHIELD OF TENNESSEE