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NPI Code Detail

MEDICARE: MEDICOM LLC

MEDICARE: MEDICOM 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
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1790849867
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICOM LLC
Provider Business Mailing Address
First Line : 137 S MAIN ST
Second Line :
City : ARAB
State : AL
Zip : 35016-1354
Country : US
Telephone Number : 256-931-2035
Fax Number : 256-931-0634
Provider Business Practice Location Address
First Line : 137 S MAIN ST
Second Line :
City : ARAB
State : AL
Zip : 35016-1354
Country : US
Telephone Number : 256-931-2035
Fax Number : 256-931-0634
Authorized Official
Title or Position : OFFICE MANAGER
Name : MARIANNE ELRICK
Credential : RN
Telephone Number : 256-931-2035
Provider Enumeration Date : 12/21/2006
Last Update Date : 08/22/2020

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Directions to “MEDICOM LLC ” Practice Location

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