Provider Demographics
NPI:1336474964
Name:SLCM LLC
Entity Type:Organization
Organization Name:SLCM LLC
Other - Org Name:NORTHRIVER PRIMARY CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-710-6129
Mailing Address - Street 1:4310 WATERMELON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5166
Mailing Address - Country:US
Mailing Address - Phone:205-330-5266
Mailing Address - Fax:205-330-9915
Practice Address - Street 1:4310 WATERMELON RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5166
Practice Address - Country:US
Practice Address - Phone:205-330-5266
Practice Address - Fax:205-330-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1336474964Medicaid
ALDP9610OtherMEDICARE RAILROAD
AL102G708389Medicare PIN