Provider Demographics
NPI:1194819375
Name:LONG-TERM CARE PHYSICIANS OF ALABAMA INC
Entity Type:Organization
Organization Name:LONG-TERM CARE PHYSICIANS OF ALABAMA INC
Other - Org Name:LONG-TERM CARE PHYSICIANS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:256-739-9593
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-0339
Mailing Address - Country:US
Mailing Address - Phone:256-739-9593
Mailing Address - Fax:256-739-3680
Practice Address - Street 1:401 ARNOLD ST NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-1919
Practice Address - Country:US
Practice Address - Phone:256-739-9593
Practice Address - Fax:256-739-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529402080Medicaid
ALG765Medicare ID - Type Unspecified
AL529402080Medicaid