SOUTHERN DIVINE FAMILY MEDICAL CENTER LLC (NPI# 1104456920) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104456920 |
| Entity Type | Organization |
| Organization Name | SOUTHERN DIVINE FAMILY MEDICAL CENTER LLC |
| Other Organization Name | UNITED DOCTORS FAMILY MEDICAL CENTER - ALTOONA |
| Practice Address |
7130 6th Ave Altoona AL 35952-9052 |
| Mailing Address |
7094 Forest Mill Dr Cottondale AL 35453-1446 |
| Practice Telephone | 2055891092 |
| Practice Fax Number | 2055891096 |
| Enumeration Date | 2020-01-21 |
| Last Update Date | 2020-09-16 |
| Authorized Official Name | MICHELLE HAWTHORNE (CREDENTIALING COORDINATOR) |
| Authorized Official Telephone | 2052922428 |
| Authorized Official Credential | MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| United Doctors Family Medical Center - Altoona | Doing Business As Name - Organization |
| Street Address |
7130 6TH AVE |
| City | ALTOONA |
| State | AL |
| Zip Code | 35952-9052 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588839096 | Town of Altoona | Ambulance | 2844 Main Street, Altoona, AL 35952 | 2008-04-25 |
| 1881812857 | Klein Drug Shoppe, Inc | Pharmacy | 87490 Us Highway 278, Altoona, AL 35952 | 2007-04-23 |
| 1023143484 | Bhc-blount & Etowah Counties | Family Medicine | 180 Medical Street, Snead, AL 35952 | 2007-02-23 |
| 1801937149 | Angie Vaughan | Pharmacist | 87490 Us Hwy 278, Altoona, AL 35952 | 2007-02-09 |
| 1851326540 | Kelly S Knowles | Physical Therapist | 200 Medical St, Snead, AL 35952 | 2006-07-11 |
| 1588615959 | Quality of Life Health Services, Inc | Clinic/Center | 4350 Cleveland Ave, Walnut Grove, AL 35952 | 2006-05-12 |
| 1104887181 | James Richard Anderson Sr. | Pharmacist | 7101 Etowah St, Altoona, AL 35952 | 2006-03-30 |
| 1083609606 | William Leonard Gibson | Emergency Medicine | 180 Medical St, Baptist Health Center - Snead, Snead, AL 35952 | 2005-09-20 |
| 1649477407 | William Matthew Fallin | Physician Assistant | 180 Medical Street, Snead, AL 35952 | 2007-06-27 |
| 1699080887 | James Richard Anderson Jr. | Pharmacist | 3850 Bud Umphrey Rd, Altoona, AL 35952-0328 | 2010-08-11 |
| Find all providers in zip 35952 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932480571 | Duminda S Siripala | Internal Medicine | 312 Chestnut Avenue, Altoona, PA 16601-4911 | 2011-09-08 |
| 1467770735 | Internal Medicine Associates of Altoona | Internal Medicine | 501 Howard Ave Bldg B, Altoona, PA 16601-4810 | 2010-05-12 |
| 1699925107 | Dr Hadleys Housecall Service PC | Internal Medicine | 2703 Fairway Dr, 1c, Altoona, PA 16602-4442 | 2008-09-22 |
| 1447453352 | Jules Leonard Netreba | Internal Medicine | 4308 2nd Ave, Altoona, PA 16602-1506 | 2007-06-07 |
| 1104934132 | Michele Lee Bauer | Internal Medicine | 2503 N Hillcrest Pkwy, Altoona, WI 54720-2569 | 2006-08-29 |
| 1144239443 | Maged M Zaky | Internal Medicine | 1414 9th Ave., 1414, Altoona, PA 16602 | 2006-08-05 |
| 1952318891 | Altoona Internal Medicine P.C. | Internal Medicine | 1710 6th Ave, Altoona, PA 16602-2324 | 2006-08-02 |
| 1790702330 | Kumbalatara A Siripala | Internal Medicine | 312 Chestnut Ave, Altoona, PA 16601-4911 | 2006-07-17 |
| 1922063403 | Mohammad N Dowlut | Internal Medicine | 1400 Logan Blvd, Altoona, PA 16602 | 2006-04-19 |
| 1629041785 | Hassan Yassin Zammam | Internal Medicine | 2950 Fairway Dr, Suite # 2, Altoona, PA 16602-4494 | 2006-02-09 |
| Find all providers in ALTOONA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.