Healthcare Provider Details

I. General information

NPI: 1871003533
Provider Name (Legal Business Name): LV STABLER PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N COLLEGE ST
GREENVILLE AL
36037-2025
US

IV. Provider business mailing address

29 L V STABLER DR
GREENVILLE AL
36037-3850
US

V. Phone/Fax

Practice location:
  • Phone: 334-382-2681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA SALTER
Title or Position: DIRECTOR
Credential:
Phone: 334-371-5025