MEDICARE: GADSDEN REGIONAL PRIMARY CARE 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1972566743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GADSDEN REGIONAL PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	3212 RAINBOW DR
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-5805
Country	:	US
Telephone Number	:	256-442-7683
Fax Number	:

Provider Business Practice Location Address
First Line	:	3212 RAINBOW DR
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-5805
Country	:	US
Telephone Number	:	256-442-7683
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PROVIDER ENROLLMENT
Name	:	DEBBIE BREWER
Credential	:
Telephone Number	:	615-465-7000

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	10/19/2007

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