| Eastside Family Medicine | |
|
22289 Medical Village Dr Athens AL 35613-2896 | |
| (256) 232-1414 | |
| Not Available |
| Full Name | Eastside Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 22289 Medical Village Dr, Athens, Alabama |
| Authorized Official Name and Position | Sebrina B Holt (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2562169648 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastside Family Medicine 22289 Medical Village Dr Athens AL 35613-2896 Ph: (256) 232-1414 | Eastside Family Medicine 22289 Medical Village Dr Athens AL 35613-2896 Ph: (256) 232-1414 |
| NPI Number | 1962946970 |
|---|---|
| Provider Enumeration Date | 12/09/2016 |
| Last Update Date | 01/05/2024 |
| Medicare PECOS PAC ID | 9032494935 |
|---|---|
| Medicare Enrollment ID | O20170315002083 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962946970 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Max R Boone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346352317 PECOS PAC ID: 4183728223 Enrollment ID: I20070330000098 |
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