Healthcare Provider Details

I. General information

NPI: 1922440551
Provider Name (Legal Business Name): TUSCALOOSA FOCUS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ENERGY CENTER BLVD STE 504
NORTHPORT AL
25473-2794
US

IV. Provider business mailing address

PO BOX 8159
MOBILE AL
36689-0159
US

V. Phone/Fax

Practice location:
  • Phone: 205-301-2837
  • Fax: 205-543-5530
Mailing address:
  • Phone: 251-414-5810
  • Fax: 251-414-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK THOMAS
Title or Position: OWNER
Credential: MD
Phone: 205-301-2837