Provider Demographics
NPI:1801191846
Name:RCHP-FLORENCE, LLC
Entity Type:Organization
Organization Name:RCHP-FLORENCE, LLC
Other - Org Name:SHOALS PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-844-9840
Mailing Address - Street 1:PO BOX 10005
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-2005
Mailing Address - Country:US
Mailing Address - Phone:256-768-9191
Mailing Address - Fax:256-768-9775
Practice Address - Street 1:203 AVALON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2869
Practice Address - Country:US
Practice Address - Phone:256-386-1450
Practice Address - Fax:256-386-1463
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RCHP- FLORENCE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-24
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.30640208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102G706051Medicare PIN