Healthcare Provider Details

I. General information

NPI: 1861765638
Provider Name (Legal Business Name): FAMILY CARE FIRST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 HIGHWAY 13
HALEYVILLE AL
35565-1638
US

IV. Provider business mailing address

1023 AL. HWY 13
HALEYVILLE AL
35565
US

V. Phone/Fax

Practice location:
  • Phone: 205-269-5036
  • Fax:
Mailing address:
  • Phone: 205-486-5050
  • Fax: 205-486-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateAL

VIII. Authorized Official

Name: MR. JERRE S. GLOVER JR.
Title or Position: OWNER
Credential:
Phone: 256-227-0571