Provider Demographics
NPI:1730499906
Name:BULLOCK FAMILY CARE CENTER LLC
Entity Type:Organization
Organization Name:BULLOCK FAMILY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:LAWRENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-386-0343
Mailing Address - Street 1:5303 VAUGHN ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1120
Mailing Address - Country:US
Mailing Address - Phone:334-386-0343
Mailing Address - Fax:334-386-0382
Practice Address - Street 1:5303 VAUGHN ROAD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1120
Practice Address - Country:US
Practice Address - Phone:334-386-0343
Practice Address - Fax:334-386-0382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty