Provider Demographics
NPI:1740459841
Name:HORSE CREEK FAMILY MEDICINE, INC.
Entity type:Organization
Organization Name:HORSE CREEK FAMILY MEDICINE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TWILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:205-648-7887
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:DORA
Mailing Address - State:AL
Mailing Address - Zip Code:35062-0366
Mailing Address - Country:US
Mailing Address - Phone:205-648-7887
Mailing Address - Fax:205-648-5115
Practice Address - Street 1:497 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMITON
Practice Address - State:AL
Practice Address - Zip Code:35148-4328
Practice Address - Country:US
Practice Address - Phone:205-648-7887
Practice Address - Fax:205-648-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center