Provider Demographics
NPI:1255481677
Name:TROY FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:TROY FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLECYA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:CHEATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-807-0235
Mailing Address - Street 1:101 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-3093
Mailing Address - Country:US
Mailing Address - Phone:334-807-0235
Mailing Address - Fax:334-807-0099
Practice Address - Street 1:101 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36079-3093
Practice Address - Country:US
Practice Address - Phone:334-807-0235
Practice Address - Fax:334-807-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00019306207Q00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01D0961776OtherCLEA
AL000044674Medicaid
AL51044674OtherBLUE CROSS PROVIDER #
AL000044674Medicaid
AL000044674Medicare ID - Type UnspecifiedMEDICARE #