| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 Ivory Pl, Madison, Alabama |
| Authorized Official Name and Position | Nemil Shah (OWNER) |
| Authorized Official Contact | 2564173386 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
101 Ivory Pl Madison AL 35758-2349 Ph: (256) 325-0236 | 101 Ivory Pl Madison AL 35758-2349 Ph: (256) 417-3386 |
| NPI Number | 1669985503 |
|---|---|
| Provider Enumeration Date | 11/14/2017 |
| Last Update Date | 07/02/2022 |
| Medicare PECOS PAC ID | 6103185145 |
|---|---|
| Medicare Enrollment ID | O20180119000244 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669985503 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Alabama) | Secondary |
| 208D00000X | General Practice | (Alabama) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
| Provider Name | Elena Allman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083817175 PECOS PAC ID: 3375702152 Enrollment ID: I20120323000429 |
| Provider Name | Nemil A Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780941740 PECOS PAC ID: 6305091737 Enrollment ID: I20141001001275 |
| Provider Name | Lauren Ashley Kellum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982178935 PECOS PAC ID: 4688913015 Enrollment ID: I20190302000013 |
| Provider Name | Heather Howard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902310931 PECOS PAC ID: 3375885494 Enrollment ID: I20190419000695 |
| Provider Name | Sydney Thornhill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215591128 PECOS PAC ID: 9638409956 Enrollment ID: I20190928000080 |
| Provider Name | Paige Makenzie Constant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659906980 PECOS PAC ID: 7416369178 Enrollment ID: I20201222001472 |
| Provider Name | Haven Brolsma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316541287 PECOS PAC ID: 6204242589 Enrollment ID: I20210311000489 |
| Provider Name | Tyneishia Cunningham King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235788415 PECOS PAC ID: 3072922079 Enrollment ID: I20210504000432 |
| Provider Name | Melanie Levinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659039477 PECOS PAC ID: 3375936115 Enrollment ID: I20220131001611 |
| Provider Name | Tiffiney Oleyte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720319825 PECOS PAC ID: 8325385669 Enrollment ID: I20240520000755 |
Dr. Sunita Puri Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8075 Madison Blvd Ste 106, Madison, AL 35758 Phone: 256-464-6004 Fax: 256-464-0403 | |
Caswall C Harrigan Physician Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Madison Medical Plaza 540 Hughes Road, Suite 14, Madison, AL 35758 Phone: 256-426-0802 | |
Tennessee Valley Internal Medicine, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3809 Sullivan St, Suite 7, Madison, AL 35758 Phone: 256-428-1096 Fax: 256-428-1097 | |
American Family Care, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7559 Hwy 72 W, Madison, AL 35758 Phone: 256-562-0850 Fax: 256-562-0854 | |
Madison Family Health, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3776 Sullivan St, Suite D, Madison, AL 35758 Phone: 256-325-0302 Fax: 256-325-0391 |