Provider Demographics
NPI:1376615476
Name:WEST ALABAMA FAMILY PRACTICE & SPORTS MEDICINE PC
Entity Type:Organization
Organization Name:WEST ALABAMA FAMILY PRACTICE & SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUETTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-339-0171
Mailing Address - Street 1:100 RICE MINE ROAD LOOP
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2425
Mailing Address - Country:US
Mailing Address - Phone:205-339-0171
Mailing Address - Fax:205-333-8681
Practice Address - Street 1:100 RICE MINE ROAD LOOP
Practice Address - Street 2:SUITE 206
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2425
Practice Address - Country:US
Practice Address - Phone:205-339-0171
Practice Address - Fax:205-333-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG474Medicare PIN
AL1104250001Medicare NSC
ALG474Medicare PIN