Provider Demographics
NPI:1801097597
Name:CREEKSIDE FAMILY PRACTICE
Entity type:Organization
Organization Name:CREEKSIDE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KINZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-551-6503
Mailing Address - Street 1:810 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4310
Mailing Address - Country:US
Mailing Address - Phone:256-551-6503
Mailing Address - Fax:256-533-8935
Practice Address - Street 1:810 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4310
Practice Address - Country:US
Practice Address - Phone:256-551-6503
Practice Address - Fax:256-533-8935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG64942Medicare UPIN
ALF57755Medicare UPIN
ALDB5150Medicare PIN
ALC72476Medicare UPIN
ALH84628Medicare UPIN
ALJ863Medicare PIN
ALG96106Medicare UPIN
G64942Medicare UPIN