Provider Demographics
NPI:1184688681
Name:FIRST CARE MEDICAL CLINIC
Entity type:Organization
Organization Name:FIRST CARE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:OLUWOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:AKISANYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-543-9955
Mailing Address - Street 1:311 SOUTH 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5212
Mailing Address - Country:US
Mailing Address - Phone:256-543-9955
Mailing Address - Fax:256-543-9351
Practice Address - Street 1:311 SOUTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5212
Practice Address - Country:US
Practice Address - Phone:256-543-9955
Practice Address - Fax:256-543-9351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000060841Medicaid
G52157Medicare UPIN
AL000060841Medicaid
ALG52157Medicare UPIN
AL000060841Medicare ID - Type Unspecified