Provider Demographics
NPI:1700837010
Name:FAMILY PRACTICE CENTER OF HUNTSVILLE PC
Entity Type:Organization
Organization Name:FAMILY PRACTICE CENTER OF HUNTSVILLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR-MORNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-539-6900
Mailing Address - Street 1:401 LOWELL DR SE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3748
Mailing Address - Country:US
Mailing Address - Phone:256-539-6900
Mailing Address - Fax:256-539-6997
Practice Address - Street 1:401 LOWELL DR SE
Practice Address - Street 2:SUITE 22
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3748
Practice Address - Country:US
Practice Address - Phone:256-539-6900
Practice Address - Fax:256-539-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14537261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000022751OtherMEDICARE PTAN
AL529403070Medicaid
ALE20868Medicare UPIN