Provider Demographics
NPI:1841366903
Name:TUSCALOOSA FAMILY PRACTICE AND OBSTETRICS, P.C.
Entity type:Organization
Organization Name:TUSCALOOSA FAMILY PRACTICE AND OBSTETRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEDMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-752-9500
Mailing Address - Street 1:701 UNIVERSITY BLVD E
Mailing Address - Street 2:SUITE 507
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2086
Mailing Address - Country:US
Mailing Address - Phone:205-752-9500
Mailing Address - Fax:205-752-9662
Practice Address - Street 1:701 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 507
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2086
Practice Address - Country:US
Practice Address - Phone:205-752-9500
Practice Address - Fax:205-752-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE810Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER