Provider Demographics
NPI:1790093441
Name:FAMILY CARE FIRST, INC.
Entity Type:Organization
Organization Name:FAMILY CARE FIRST, INC.
Other - Org Name:PATIENT CARE FIRST MEDICAL CLINIC, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-905-0340
Mailing Address - Street 1:11809 AL HIGHWAY 157
Mailing Address - Street 2:STE E
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-2707
Mailing Address - Country:US
Mailing Address - Phone:256-760-4395
Mailing Address - Fax:256-760-4396
Practice Address - Street 1:2530 FLORENCE BLVD STE D
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2807
Practice Address - Country:US
Practice Address - Phone:256-760-4395
Practice Address - Fax:256-760-4396
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY CARE FIRST, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-15
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL71754261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care