MEDICARE: FOCUSAL1011, LLC

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	208000000X	Pediatrics Physician
2	2080A0000X	Pediatric Adolescent Medicine Physician

General Provider Information

NPI Number	:	1366861395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOCUSAL1011, LLC

Provider Business Mailing Address
First Line	:	PO BOX 8159
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36689-0159
Country	:	US
Telephone Number	:	888-414-5810
Fax Number	:	251-414-5809

Provider Business Practice Location Address
First Line	:	2202 JORDAN RD SW STE 501
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3691
Country	:	US
Telephone Number	:	888-414-5810
Fax Number	:	251-414-5809

Authorized Official
Title or Position	:	OWNER/MEDICAL DIRECTOR
Name	:	FRINE T ROCA
Credential	:	MD
Telephone Number	:	888-414-5810

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	04/07/2014

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