Provider Demographics
NPI:1710384359
Name:TROY REGIONAL PHYSICIANS, INC
Entity Type:Organization
Organization Name:TROY REGIONAL PHYSICIANS, INC
Other - Org Name:TROY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:334-670-5427
Mailing Address - Street 1:1330 HIGHWAY 231 S
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-3058
Mailing Address - Country:US
Mailing Address - Phone:334-566-0546
Mailing Address - Fax:
Practice Address - Street 1:1320 HIGHWAY 231 S
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3000
Practice Address - Country:US
Practice Address - Phone:334-566-0546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TROY REGIONAL PHYSICIANS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-25
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL124556Medicaid
AL124556Medicaid