Provider Demographics
NPI:1811031883
Name:FAMILY MEDICINE FOR YOUR FAMILY PC
Entity Type:Organization
Organization Name:FAMILY MEDICINE FOR YOUR FAMILY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-259-4100
Mailing Address - Street 1:505 BURLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-4216
Mailing Address - Country:US
Mailing Address - Phone:256-259-4100
Mailing Address - Fax:256-259-4104
Practice Address - Street 1:505 BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4216
Practice Address - Country:US
Practice Address - Phone:256-259-4100
Practice Address - Fax:256-259-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529925920Medicaid
ALK616Medicare ID - Type Unspecified