Provider Demographics
NPI:1407056252
Name:SHOALS MEDICAL CLINIC, PC
Entity Type:Organization
Organization Name:SHOALS MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:LAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-381-5234
Mailing Address - Street 1:1404 E AVALON AVE
Mailing Address - Street 2:SUITE B-00
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-1773
Mailing Address - Country:US
Mailing Address - Phone:256-381-5234
Mailing Address - Fax:256-381-5232
Practice Address - Street 1:1404 E AVALON AVE
Practice Address - Street 2:SUITE B-00
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1773
Practice Address - Country:US
Practice Address - Phone:256-381-5234
Practice Address - Fax:256-381-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL24815OtherBCBS
AL24815OtherBCBS