| Tuskaloosa Internal Medicine Llc | |
|
1100 Ruby Tyler Pkwy Tuscaloosa AL 35404-2959 | |
| (205) 759-2582 | |
| (205) 759-2985 |
| Full Name | Tuskaloosa Internal Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1100 Ruby Tyler Pkwy, Tuscaloosa, Alabama |
| Authorized Official Name and Position | Ross B Vaughn (PARTNER) |
| Authorized Official Contact | 2057592582 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tuskaloosa Internal Medicine Llc 1100 Ruby Tyler Pkwy Tuscaloosa AL 35404-2959 Ph: (205) 759-2582 | Tuskaloosa Internal Medicine Llc 1100 Ruby Tyler Pkwy Tuscaloosa AL 35404-2959 Ph: (205) 759-2582 |
| NPI Number | 1235221847 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 03/01/2013 |
| Medicare PECOS PAC ID | 2264451137 |
|---|---|
| Medicare Enrollment ID | O20051121000551 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235221847 | NPI | - | NPPES |
| 528601940 | Medicaid | AL | |
| CC0235 | Other | AL | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Alabama) | Primary |
| Provider Name | Scott R Fulgham |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881785749 PECOS PAC ID: 7113820861 Enrollment ID: I20040129000862 |
| Provider Name | Jenna R Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790883429 PECOS PAC ID: 7416976386 Enrollment ID: I20051121000565 |
| Provider Name | Ross B Vaughn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184715021 PECOS PAC ID: 9436178308 Enrollment ID: I20051205000367 |
| Provider Name | Leonard W Jones |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366533218 PECOS PAC ID: 2163441031 Enrollment ID: I20051205000830 |
| Provider Name | Scott L Arnold |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467476358 PECOS PAC ID: 1254395379 Enrollment ID: I20060821000097 |
| Provider Name | John Warren |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013120104 PECOS PAC ID: 8921186628 Enrollment ID: I20080422000212 |
| Provider Name | John P Summerford |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659472009 PECOS PAC ID: 7618996588 Enrollment ID: I20101111000279 |
| Provider Name | John P Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104087469 PECOS PAC ID: 7719142843 Enrollment ID: I20120622000343 |
| Provider Name | Theresa Darlene Putman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609114198 PECOS PAC ID: 8325283989 Enrollment ID: I20130402000284 |
| Provider Name | Jayne K Graben |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104220946 PECOS PAC ID: 7911223433 Enrollment ID: I20150227001238 |
| Provider Name | Lesley A Handjis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780075077 PECOS PAC ID: 4587984877 Enrollment ID: I20150528001211 |
| Provider Name | Angela Herndon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316327638 PECOS PAC ID: 1254769375 Enrollment ID: I20200323002948 |
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