Healthcare Provider Details

I. General information

NPI: 1780567610
Provider Name (Legal Business Name): CORDOVA FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BREWER ST
CORDOVA AL
35550-1256
US

IV. Provider business mailing address

PO BOX 330
CORDOVA AL
35550-0330
US

V. Phone/Fax

Practice location:
  • Phone: 205-740-7070
  • Fax: 205-740-5407
Mailing address:
  • Phone: 205-740-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AUTUMN MUMMEY
Title or Position: OWNER
Credential: NP
Phone: 205-740-7070