Provider Demographics
NPI:1467549147
Name:DR TAMARA MCINTOSH LLC
Entity Type:Organization
Organization Name:DR TAMARA MCINTOSH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:256-892-2121
Mailing Address - Street 1:1410 AL HWY 144
Mailing Address - Street 2:
Mailing Address - City:OHATCHEE
Mailing Address - State:AL
Mailing Address - Zip Code:36271-7887
Mailing Address - Country:US
Mailing Address - Phone:256-892-2121
Mailing Address - Fax:256-892-3733
Practice Address - Street 1:1410 AL HIGHWAY 144
Practice Address - Street 2:
Practice Address - City:OHATCHEE
Practice Address - State:AL
Practice Address - Zip Code:36271-7887
Practice Address - Country:US
Practice Address - Phone:256-892-2121
Practice Address - Fax:256-892-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51538228OtherBLUE CROSS BLUE SHIELD
AL51538228OtherBLUE CROSS BLUE SHIELD
AL51538228OtherBLUE CROSS BLUE SHIELD
AL=========OtherTRICARE