Provider Demographics
NPI:1407339328
Name:PRICEVILLE PRIMARY CARE
Entity Type:Organization
Organization Name:PRICEVILLE PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR EMPLOYED PHYSICIAN NETWORK
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-973-2798
Mailing Address - Street 1:1201 7TH ST SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3337
Mailing Address - Country:US
Mailing Address - Phone:256-973-2802
Mailing Address - Fax:256-973-2552
Practice Address - Street 1:68 MARCO DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-5425
Practice Address - Country:US
Practice Address - Phone:256-973-2802
Practice Address - Fax:256-686-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
ALRN1-151783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty