MEDICARE: CARE PLUS MEDICAL CLINIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-055027	AL

General Provider Information

NPI Number	:	1053422105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE PLUS MEDICAL CLINIC, INC

Provider Business Mailing Address
First Line	:	1001 S JACKSON HWY
Second Line	:
City	:	SHEFFIELD
State	:	AL
Zip	:	35660-5760
Country	:	US
Telephone Number	:	256-386-7774
Fax Number	:	256-386-7780

Provider Business Practice Location Address
First Line	:	1001 S JACKSON HWY
Second Line	:
City	:	SHEFFIELD
State	:	AL
Zip	:	35660-5760
Country	:	US
Telephone Number	:	256-386-7774
Fax Number	:	256-386-7780

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MARILYN DAVIS MCANALLEY
Credential	:	CRNP
Telephone Number	:	256-386-7774

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/01/2011

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