Provider Demographics
NPI:1710168257
Name:EAST ALABAMA PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:EAST ALABAMA PRIMARY CARE, LLC
Other - Org Name:EAST ALABAMA GENERAL MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUBINDEEP
Authorized Official - Middle Name:RUBY
Authorized Official - Last Name:POWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:334-321-0060
Mailing Address - Street 1:1518 PROFESSIONAL PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2857
Mailing Address - Country:US
Mailing Address - Phone:334-321-0660
Mailing Address - Fax:
Practice Address - Street 1:1518 PROFESSIONAL PKWY STE A
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2857
Practice Address - Country:US
Practice Address - Phone:334-321-0660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207Q00000X
AL13044207RG0100X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000024978Medicaid
AL529933007Medicaid