Healthcare Provider Details

I. General information

NPI: 1083937452
Provider Name (Legal Business Name): NW ALABAMA PRACTICE MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S JACKSON HWY SUITE 206
SHEFFIELD AL
35660-5777
US

IV. Provider business mailing address

PO BOX 895
SHEFFIELD AL
35660-0895
US

V. Phone/Fax

Practice location:
  • Phone: 256-386-5898
  • Fax: 256-386-5898
Mailing address:
  • Phone: 256-386-4557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateAL

VIII. Authorized Official

Name: MRS. PENNY WESTMORLAND
Title or Position: CFO
Credential:
Phone: 256-386-4550