Provider Demographics
NPI:1104922368
Name:HALEYVILLE MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:HALEYVILLE MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:V
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, BA
Authorized Official - Phone:205-486-8899
Mailing Address - Street 1:42320 HWY 195
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-7015
Mailing Address - Country:US
Mailing Address - Phone:205-486-8899
Mailing Address - Fax:205-486-8908
Practice Address - Street 1:42320 HWY 195
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-7015
Practice Address - Country:US
Practice Address - Phone:205-486-8899
Practice Address - Fax:205-486-8908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALGR#529925490Medicaid
ALGR#529925490Medicaid