Provider Demographics
NPI:1952484081
Name:MANAGEMENT AND MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:MANAGEMENT AND MEDICAL SERVICES, LLC
Other - Org Name:CHILDERSBURG PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-378-3313
Mailing Address - Street 1:34011 HIGHWAY 280 EAST
Mailing Address - Street 2:
Mailing Address - City:CHILDERSBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35044
Mailing Address - Country:US
Mailing Address - Phone:256-378-3313
Mailing Address - Fax:256-378-3315
Practice Address - Street 1:34011 HIGHWAY 280 EAST
Practice Address - Street 2:
Practice Address - City:CHILDERSBURG
Practice Address - State:AL
Practice Address - Zip Code:35044
Practice Address - Country:US
Practice Address - Phone:256-378-3313
Practice Address - Fax:256-378-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ605Medicare ID - Type Unspecified