Provider Demographics
NPI:1477664779
Name:SARALAND FAMILY PRACT PC
Entity Type:Organization
Organization Name:SARALAND FAMILY PRACT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-544-2000
Mailing Address - Street 1:119 ENNIS ST
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-2706
Mailing Address - Country:US
Mailing Address - Phone:251-544-2000
Mailing Address - Fax:251-544-2004
Practice Address - Street 1:119 ENNIS ST
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2706
Practice Address - Country:US
Practice Address - Phone:251-544-2000
Practice Address - Fax:251-544-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K961OtherMEDICARE GROUP