Provider Demographics
NPI:1275774721
Name:CENTRO MEDICO FAMILIAR /FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:CENTRO MEDICO FAMILIAR /FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:BLUMER CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-281-2966
Mailing Address - Street 1:106 W ROSETTA AVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2224
Mailing Address - Country:US
Mailing Address - Phone:251-281-2966
Mailing Address - Fax:
Practice Address - Street 1:106 W ROSETTA AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2224
Practice Address - Country:US
Practice Address - Phone:251-281-2966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27491208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1366525099OtherNPI
AL1306893771OtherNPI