Provider Demographics
NPI:1689091548
Name:EASTSIDE FAMILY CARE LLC
Entity Type:Organization
Organization Name:EASTSIDE FAMILY CARE LLC
Other - Org Name:EASTSIDE URGENT CARE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAI
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAMBURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-524-3266
Mailing Address - Street 1:14 MITYLENE PARK LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7306
Mailing Address - Country:US
Mailing Address - Phone:334-213-4433
Mailing Address - Fax:
Practice Address - Street 1:14 MITYLENE PARK LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117
Practice Address - Country:US
Practice Address - Phone:334-524-3266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty