Healthcare Provider Details

I. General information

NPI: 1992914238
Provider Name (Legal Business Name): HUNTSVILLE HOSPITAL MADISON INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 LANIER RD
MADISON AL
35758-1866
US

IV. Provider business mailing address

PO BOX 21007
HUNTSVILLE AL
35813-5007
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-5970
  • Fax: 256-265-5971
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLINTON CARTER
Title or Position: CFO
Credential:
Phone: 256-265-8818