Provider Demographics
NPI:1922440551
Name:TUSCALOOSA FOCUS MD LLC
Entity Type:Organization
Organization Name:TUSCALOOSA FOCUS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-301-2837
Mailing Address - Street 1:PO BOX 8159
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36689-0159
Mailing Address - Country:US
Mailing Address - Phone:251-414-5810
Mailing Address - Fax:251-414-5809
Practice Address - Street 1:720 ENERGY CENTER BLVD
Practice Address - Street 2:STE 504
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:25473-2794
Practice Address - Country:US
Practice Address - Phone:205-301-2837
Practice Address - Fax:205-543-5530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL152344Medicaid