Healthcare Provider Details

I. General information

NPI: 1316103237
Provider Name (Legal Business Name): WILLS VALLEY FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13280 COUNTY ROAD 51
COLLINSVILLE AL
35961-4174
US

IV. Provider business mailing address

13280 COUNTY ROAD 51
COLLINSVILLE AL
35961-4174
US

V. Phone/Fax

Practice location:
  • Phone: 256-524-3090
  • Fax: 256-524-2885
Mailing address:
  • Phone: 256-524-3090
  • Fax: 256-524-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCES H KOE
Title or Position: OWNER
Credential: MD
Phone: 256-524-3090