=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447262977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST ALABAMA FAMILY PHYSICIANS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1251 MCFARLAND BLVD NE
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35406-2205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-349-2323
-----------------------------------------------------
Fax | 205-349-1155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2330 UNIVERSITY BLVD SUITE 501
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35401-1599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-344-9021
-----------------------------------------------------
Fax | 205-344-9031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. DERICK MORRING BEEM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-344-9019
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 221475
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------