Provider Demographics
NPI:1447262977
Name:WEST ALABAMA FAMILY PHYSICIANS
Entity type:Organization
Organization Name:WEST ALABAMA FAMILY PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DERICK
Authorized Official - Middle Name:MORRING
Authorized Official - Last Name:BEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-344-9019
Mailing Address - Street 1:2330 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1599
Mailing Address - Country:US
Mailing Address - Phone:205-344-9021
Mailing Address - Fax:205-344-9031
Practice Address - Street 1:1251 MCFARLAND BLVD NE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2205
Practice Address - Country:US
Practice Address - Phone:205-349-2323
Practice Address - Fax:205-349-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL221475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherBLUECROSSBLUESHIELD OF AL
AL=========OtherBLUECROSSBLUESHIELD OF AL
ALD343Medicare ID - Type Unspecified