Provider Demographics
NPI:1518652395
Name:RESIDENTIAL MEDICINE LLC
Entity Type:Organization
Organization Name:RESIDENTIAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCENEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:205-245-3422
Mailing Address - Street 1:50 COUNTY ROAD 52
Mailing Address - Street 2:
Mailing Address - City:JEMISON
Mailing Address - State:AL
Mailing Address - Zip Code:35085-5068
Mailing Address - Country:US
Mailing Address - Phone:205-210-8191
Mailing Address - Fax:205-891-8189
Practice Address - Street 1:50 COUNTY ROAD 52
Practice Address - Street 2:
Practice Address - City:JEMISON
Practice Address - State:AL
Practice Address - Zip Code:35085-5068
Practice Address - Country:US
Practice Address - Phone:205-210-8191
Practice Address - Fax:205-891-8189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty