Healthcare Provider Details

I. General information

NPI: 1295830891
Provider Name (Legal Business Name): TOTAL SPORTS CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BALMORAL DRIVE SUITE 200
HUNTSVILLE AL
35801
US

IV. Provider business mailing address

4205 BALMORAL DRIVE SUITE 200
HUNTSVILLE AL
35801
US

V. Phone/Fax

Practice location:
  • Phone: 256-382-7767
  • Fax: 256-880-5262
Mailing address:
  • Phone: 256-382-7767
  • Fax: 256-880-5262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number94689
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number97264
License Number StateAL

VIII. Authorized Official

Name: DR. DARLA R COWART
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 256-382-7767