Provider Demographics
NPI:1760614796
Name:WEST LIMESTONE FAMILY CARE LLC
Entity Type:Organization
Organization Name:WEST LIMESTONE FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-777-6805
Mailing Address - Street 1:PO BOX 1044
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35612-1044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25678 WEST LIMESTONE SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:ELKMONT
Practice Address - State:AL
Practice Address - Zip Code:35620-7938
Practice Address - Country:US
Practice Address - Phone:256-777-6805
Practice Address - Fax:256-614-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-09
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty