Provider Demographics
NPI:1780192765
Name:FAMILY FIRST MEDICINE LLC
Entity Type:Organization
Organization Name:FAMILY FIRST MEDICINE LLC
Other - Org Name:FAMILY FIRST MEDICINE OF SCOTTSBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAPPS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:205-874-8306
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-0649
Mailing Address - Country:US
Mailing Address - Phone:256-226-7573
Mailing Address - Fax:
Practice Address - Street 1:1601 VETERANS DRIVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35769
Practice Address - Country:US
Practice Address - Phone:256-638-9161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY FIRST MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherIRS