Provider Demographics
NPI:1619080017
Name:ANNISTON MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:ANNISTON MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RHEUMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:VISHALA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINDALORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-236-5631
Mailing Address - Street 1:PO BOX 2127
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-2127
Mailing Address - Country:US
Mailing Address - Phone:256-236-5631
Mailing Address - Fax:256-241-2241
Practice Address - Street 1:1010 CHRISTINE AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5710
Practice Address - Country:US
Practice Address - Phone:256-236-5631
Practice Address - Fax:256-241-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207Q00000X, 207R00000X, 207RH0003X, 207RP1001X, 207RR0500X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00013001OtherNHC HEALTH BENEFIT PLAN
AL000060227Medicaid
ALF143Medicare PIN
ALC227Medicare PIN
AL00013001OtherNHC HEALTH BENEFIT PLAN