Provider Demographics
NPI:1558918342
Name:LV STABLER PRIMARY CARE LLC
Entity Type:Organization
Organization Name:LV STABLER PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-371-5025
Mailing Address - Street 1:300 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-2025
Mailing Address - Country:US
Mailing Address - Phone:334-371-5025
Mailing Address - Fax:
Practice Address - Street 1:45 MEDICAL ARTS CT STE 2
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3872
Practice Address - Country:US
Practice Address - Phone:334-382-1632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty