Provider Demographics
NPI:1477629434
Name:TEMPLE MEDICAL CLINIC, PC
Entity Type:Organization
Organization Name:TEMPLE MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PITTS
Authorized Official - Last Name:TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-234-4295
Mailing Address - Street 1:859 AIRPORT DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3443
Mailing Address - Country:US
Mailing Address - Phone:256-234-4295
Mailing Address - Fax:256-329-1024
Practice Address - Street 1:859 AIRPORT DRIVE
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3443
Practice Address - Country:US
Practice Address - Phone:256-234-4295
Practice Address - Fax:256-329-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCG2343OtherMEDICARE TRAVELERS
AL529703750Medicaid
ALCG2343OtherMEDICARE TRAVELERS