Provider Demographics
NPI:1336209246
Name:ENMPC
Entity Type:Organization
Organization Name:ENMPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-494-0990
Mailing Address - Street 1:100 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1134
Mailing Address - Country:US
Mailing Address - Phone:256-494-0990
Mailing Address - Fax:256-494-0948
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 305
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1134
Practice Address - Country:US
Practice Address - Phone:256-494-0990
Practice Address - Fax:256-494-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00022313207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ109Medicare ID - Type UnspecifiedMEDICARE GROUP ID
G59563Medicare UPIN
H55411Medicare UPIN