| Coosa Family Care Llc | |
|
310 W Grand Ave Rainbow City AL 35906 | |
| (256) 459-5132 | |
| (256) 459-5179 |
| Full Name | Coosa Family Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 310 W Grand Ave, Rainbow City, Alabama |
| Authorized Official Name and Position | Kristopher Holder (OWNER/MANAGER) |
| Authorized Official Contact | 2564595132 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coosa Family Care Llc 310 W Grand Ave Rainbow City AL 35906 Ph: (256) 459-5132 | Coosa Family Care Llc 310 W Grand Ave Rainbow City AL 35906 Ph: (256) 459-5132 |
| NPI Number | 1578113221 |
|---|---|
| Provider Enumeration Date | 09/15/2019 |
| Last Update Date | 10/31/2022 |
| Medicare PECOS PAC ID | 8325470271 |
|---|---|
| Medicare Enrollment ID | O20191114000003 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578113221 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Frederick W Kelly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750327854 PECOS PAC ID: 3072582071 Enrollment ID: I20040929000413 |
| Provider Name | Adam M Alterman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619177763 PECOS PAC ID: 0244313997 Enrollment ID: I20080219000203 |
| Provider Name | Jordan C Holder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124529789 PECOS PAC ID: 7517212863 Enrollment ID: I20180611000803 |
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