NPIMap

Organization Active NPI

Eufaula Family Medicine

  • Family Medicine Physician
  • Eufaula, AL
National Provider Identifier
1023216801
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
22858 Issued in AL
Legal business name
EUFAULA FAMILY MEDICINE
Practice address
617 E Broad St
B
Eufaula, AL 36027
Phone
(334) 687-0112
Fax
(334) 687-0113
NPI assigned
Jul 3, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard Shack, MD
Title
Owner
Phone
(334) 687-0112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 22858 AL Primary

Addresses

Primary practice location

617 E Broad St
B
Eufaula, AL 36027

Mailing address

617 E Broad St
B
Eufaula, AL 36027
Phone (334) 687-0112

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023216801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 E BROAD ST",
            "address_2": "B",
            "city": "EUFAULA",
            "state": "AL",
            "postal_code": "36027",
            "telephone_number": "334-687-0112",
            "fax_number": "334-687-0113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 E BROAD ST",
            "address_2": "B",
            "city": "EUFAULA",
            "state": "AL",
            "postal_code": "36027",
            "telephone_number": "334-687-0112",
            "fax_number": "334-687-0113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EUFAULA FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHACK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "334-687-0112",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "22858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eufaula, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.