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General NPI Number Information
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NPI Number | 1235617333
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Entity Type | Organization
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Legal Business Name | LAVACA PRIMARY HEALTH SYSTEMS, LLC
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 3915 PALISADES DR STE C
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City | TUSCALOOSA
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State | AL
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Zip | 35405-3415
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Country | US
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Telephone | 205-248-2073
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 SOUTHVIEW LN # 103-140
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City | TUSCALOOSA
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State | AL
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Zip | 35405-6390
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Country | US
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Telephone | 470-235-9354
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REGINAL N VINES
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Credential |
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Telephone | 470-235-9354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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