| Bgraceful Llc | |
|
1401 Doug Baker Blvd Ste 107566 Hoover AL 35242-4974 | |
| (205) 941-6099 | |
| (205) 303-3166 |
| Full Name | Bgraceful Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1401 Doug Baker Blvd Ste 107566, Hoover, Alabama |
| Authorized Official Name and Position | Latoya M Carstarphen (OWNER/NP) |
| Authorized Official Contact | 2059416099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bgraceful Llc 1401 Doug Baker Blvd Ste 107566 Hoover AL 35242-4974 Ph: (205) 941-6099 | Bgraceful Llc 1401 Doug Baker Blvd Ste 107566 Hoover AL 35242-4974 Ph: (205) 941-6099 |
| NPI Number | 1932795390 |
|---|---|
| Provider Enumeration Date | 12/18/2020 |
| Last Update Date | 12/18/2020 |
| Medicare PECOS PAC ID | 3072927656 |
|---|---|
| Medicare Enrollment ID | O20210121001723 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932795390 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Thomas W Broughton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073778023 PECOS PAC ID: 0941472872 Enrollment ID: I20111018000711 |
| Provider Name | Latoya Carstarphen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790134369 PECOS PAC ID: 0941596837 Enrollment ID: I20160831002717 |
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