Healthcare Provider Details

I. General information

NPI: 1528467388
Provider Name (Legal Business Name): MED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 GAULT AVE N SUITE 200
FORT PAYNE AL
35967-3751
US

IV. Provider business mailing address

PO BOX 246
PISGAH AL
35765-0246
US

V. Phone/Fax

Practice location:
  • Phone: 256-451-1250
  • Fax: 256-451-1270
Mailing address:
  • Phone: 256-451-1250
  • Fax: 256-451-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD E ATA
Title or Position: OWNER
Credential: MD
Phone: 256-451-1250