Provider Demographics
NPI:1659561983
Name:NORTH ALABAMA MEDICAL ASSOCIATION LLC
Entity Type:Organization
Organization Name:NORTH ALABAMA MEDICAL ASSOCIATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:K
Authorized Official - Last Name:KANTZLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-543-2867
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49429-0523
Mailing Address - Country:US
Mailing Address - Phone:616-457-1490
Mailing Address - Fax:
Practice Address - Street 1:215 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4217
Practice Address - Country:US
Practice Address - Phone:256-543-2867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.638207Q00000X
ALDO.637207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH06188Medicare UPIN