Provider Demographics
NPI:1851614721
Name:JOHN C SIMMONS M.D.
Entity Type:Organization
Organization Name:JOHN C SIMMONS M.D.
Other - Org Name:JOHN C SIMMONS M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-295-0170
Mailing Address - Street 1:PO BOX 480070
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36748-0070
Mailing Address - Country:US
Mailing Address - Phone:334-295-0170
Mailing Address - Fax:334-295-2275
Practice Address - Street 1:100 E CAHABA AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:AL
Practice Address - Zip Code:36748-1204
Practice Address - Country:US
Practice Address - Phone:334-295-0170
Practice Address - Fax:334-295-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16795261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-03472OtherBLUE CROSS BLUE SHIELD AL
AL117645Medicaid
AL511-03472OtherBLUE CROSS BLUE SHIELD AL