Healthcare Provider Details

I. General information

NPI: 1366861395
Provider Name (Legal Business Name): FOCUSAL1011, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 JORDAN RD SW STE 501
FORT PAYNE AL
35968-3691
US

IV. Provider business mailing address

PO BOX 8159
MOBILE AL
36689-0159
US

V. Phone/Fax

Practice location:
  • Phone: 888-414-5810
  • Fax: 251-414-5809
Mailing address:
  • Phone: 888-414-5810
  • Fax: 251-414-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FRINE T ROCA
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 888-414-5810