Provider Demographics
NPI:1316223969
Name:PHYSICIANS CARE OF SWEET WATER LLC
Entity Type:Organization
Organization Name:PHYSICIANS CARE OF SWEET WATER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HUEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-636-5311
Mailing Address - Street 1:31431 ALABAMA HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:SWEET WATER
Mailing Address - State:AL
Mailing Address - Zip Code:36782-4936
Mailing Address - Country:US
Mailing Address - Phone:334-636-5311
Mailing Address - Fax:334-636-2280
Practice Address - Street 1:31431 ALABAMA HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:SWEET WATER
Practice Address - State:AL
Practice Address - Zip Code:36782-4936
Practice Address - Country:US
Practice Address - Phone:334-636-5311
Practice Address - Fax:334-636-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102G081345OtherMEDICARE PTAN