Provider Demographics
NPI:1134538572
Name:MEDAC, PC
Entity type:Organization
Organization Name:MEDAC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:334-361-8555
Mailing Address - Street 1:PO BOX 680519
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36068-0519
Mailing Address - Country:US
Mailing Address - Phone:334-361-8555
Mailing Address - Fax:866-923-0406
Practice Address - Street 1:270 INTERSTATE COMMERCIAL PARK LOOP
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7361
Practice Address - Country:US
Practice Address - Phone:334-361-8555
Practice Address - Fax:866-923-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16079261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE91876Medicare UPIN
AL1538152483Medicare PIN