Provider Demographics
NPI:1669488060
Name:AMERICAN FAMILY CARE INC
Entity Type:Organization
Organization Name:AMERICAN FAMILY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-421-2102
Mailing Address - Street 1:2147 RIVERCHASE OFFICE ROAD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244
Mailing Address - Country:US
Mailing Address - Phone:205-403-8902
Mailing Address - Fax:205-982-0278
Practice Address - Street 1:1007 9TH AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020
Practice Address - Country:US
Practice Address - Phone:205-426-9605
Practice Address - Fax:205-424-1054
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN FAMILY CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-31
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCA6570OtherRAILROAD MEDICARE
ALI215Medicare ID - Type UnspecifiedGROUP NUMBER
AL1201300020Medicare NSC