Provider Demographics
NPI:1568758274
Name:FAMILY CARE FIRST, INC
Entity Type:Organization
Organization Name:FAMILY CARE FIRST, INC
Other - Org Name:PATIENT CARE FIRST MEDICAL CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-905-0340
Mailing Address - Street 1:11809 AL HIGHWAY 157
Mailing Address - Street 2:STE E
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-2707
Mailing Address - Country:US
Mailing Address - Phone:256-905-0340
Mailing Address - Fax:256-905-0346
Practice Address - Street 1:11809 AL HIGHWAY 157
Practice Address - Street 2:STE E
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-2707
Practice Address - Country:US
Practice Address - Phone:256-905-0340
Practice Address - Fax:256-905-0346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY CARE FIRST INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-21
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 261QR1300X
AL11109261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL164012Medicaid
AL126739Medicaid
AL164012Medicaid