Provider Demographics
NPI:1457411043
Name:ISBELL MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:ISBELL MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BLAKELY
Authorized Official - Last Name:ISBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-845-8885
Mailing Address - Street 1:550 MEDICAL CENTER DR SW
Mailing Address - Street 2:PO BOX 680199
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3418
Mailing Address - Country:US
Mailing Address - Phone:256-845-8885
Mailing Address - Fax:256-845-9546
Practice Address - Street 1:550 MEDICAL CENTER DR SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3418
Practice Address - Country:US
Practice Address - Phone:256-845-8885
Practice Address - Fax:256-845-9546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528301650Medicaid
ALD863Medicare ID - Type UnspecifiedMEDICARE