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General NPI Number Information
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NPI Number | 1801097597
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Entity Type | Organization
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Legal Business Name | CREEKSIDE FAMILY PRACTICE
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 810 FRANKLIN ST SE
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City | HUNTSVILLE
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State | AL
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Zip | 35801-4310
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Country | US
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Telephone | 256-551-6503
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Fax | 256-533-8935
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Provider Business Mailing Address
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Address Line | 810 FRANKLIN ST SE
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City | HUNTSVILLE
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State | AL
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Zip | 35801-4310
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Country | US
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Telephone | 256-551-6503
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Fax | 256-533-8935
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLAUDE L KINZER
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Credential | M.D.
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Telephone | 256-551-6503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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