Northside Medical, Inc. | |
211 Greenhill Blvd Nw Fort Payne AL 35967-3755 | |
(256) 845-9355 | |
Not Available |
Full Name | Northside Medical, Inc. |
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Speciality | Clinic/Center |
Location | 211 Greenhill Blvd Nw, Fort Payne, Alabama |
Authorized Official Name and Position | Robert W. Theakston (PRESIDENT) |
Authorized Official Contact | 2568459355 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Northside Medical, Inc. Po Box 680047 Fort Payne AL 35968-1601 Ph: (256) 845-9355 | Northside Medical, Inc. 211 Greenhill Blvd Nw Fort Payne AL 35967-3755 Ph: (256) 845-9355 |
NPI Number | 1205089372 |
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Provider Enumeration Date | 11/02/2008 |
Last Update Date | 11/02/2008 |
Medicare PECOS PAC ID | 7517029937 |
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Medicare Enrollment ID | O20081218000752 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205089372 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Robert W Theakston |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1255374492 PECOS PAC ID: 8426089731 Enrollment ID: I20050826000242 |
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