Provider Demographics
NPI:1720311392
Name:AMERICAN FAMILY CARE, LLC
Entity Type:Organization
Organization Name:AMERICAN FAMILY CARE, LLC
Other - Org Name:AMERICAN FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-421-2101
Mailing Address - Street 1:2147 RIVERCHASE OFFICE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1836
Mailing Address - Country:US
Mailing Address - Phone:205-403-8902
Mailing Address - Fax:205-982-0278
Practice Address - Street 1:5569 GROVE BOULEVARD
Practice Address - Street 2:SUITE # 121
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-4600
Practice Address - Country:US
Practice Address - Phone:205-637-2600
Practice Address - Fax:205-637-2606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN FAMILY CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-14
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL208D00000X
261QP2300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529202590Medicaid
ALC417OtherBCBS GROUP #
ALCA6570OtherRAILROAD MEDICARE
ALC417Medicare PIN