Healthcare Provider Details

I. General information

NPI: 1649960873
Provider Name (Legal Business Name): PFCC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32128 BROKEN BRANCH CIR
SPANISH FORT AL
36527-6000
US

IV. Provider business mailing address

32128 BROKEN BRANCH CIR
SPANISH FORT AL
36527-6000
US

V. Phone/Fax

Practice location:
  • Phone: 251-626-6757
  • Fax: 251-626-6758
Mailing address:
  • Phone: 251-626-6757
  • Fax: 251-626-6758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHAD LEE LAMBETH
Title or Position: OWNER
Credential:
Phone: 251-626-6757