Provider Demographics
NPI:1649028960
Name:SOUTH ALABAMA FAMILY CARE, LLC
Entity type:Organization
Organization Name:SOUTH ALABAMA FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGOT
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-445-7618
Mailing Address - Street 1:10075 GRAND BAY WILMER RD S
Mailing Address - Street 2:
Mailing Address - City:GRAND BAY
Mailing Address - State:AL
Mailing Address - Zip Code:36541-5003
Mailing Address - Country:US
Mailing Address - Phone:251-865-1852
Mailing Address - Fax:251-865-1854
Practice Address - Street 1:10067 GRAND BAY WILMER RD S STE 100
Practice Address - Street 2:
Practice Address - City:GRAND BAY
Practice Address - State:AL
Practice Address - Zip Code:36541-5003
Practice Address - Country:US
Practice Address - Phone:251-810-9525
Practice Address - Fax:251-810-9536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty