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General NPI Number Information
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NPI Number | 1629392394
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Entity Type | Organization
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Legal Business Name | MEDICAL OFFICE LLC
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 04/05/2010
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Provider Practice Location Address
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Address Line | 115 E 5TH ST
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City | TUSCUMBIA
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State | AL
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Zip | 35674-2409
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Country | US
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Telephone | 256-314-0025
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Fax | 256-314-0026
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Provider Business Mailing Address
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Address Line | 115 E 5TH ST
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City | TUSCUMBIA
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State | AL
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Zip | 35674-2409
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Country | US
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Telephone | 256-314-0025
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Fax | 256-314-0026
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Authorized Official
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Title or Position | MD
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Name | JERRY A TOMLINSON
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Credential | MD
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Telephone | 256-314-0025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 9595
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License Number State | AL
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