NPIMap

Organization Active NPI

Southview Medical Clinic LLC

  • Multi-Specialty Clinic/Center
  • Hanceville, AL
National Provider Identifier
1033554357
Registry record updated Jul 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SOUTHVIEW MEDICAL CLINIC LLC
Practice address
307 Main St SW
Hanceville, AL 35077-5476
Phone
(256) 352-4767
Fax
(256) 352-4797
NPI assigned
Apr 30, 2013
Last updated
Jul 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2021

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

Authorized official

Name
Mr. Muhammad Ejaz Ata, MDNPI 1023112307
Title
Owner
Phone
(256) 451-1250

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

307 Main St SW
Hanceville, AL 35077-5476

Mailing address

307 Main St SW
Hanceville, AL 35077-5476
Phone (256) 352-4767

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130719000228 AL Part B Supplier - Clinic/Group Practice 7315188281 Receives reassigned benefits from 22 practitioners
Practice locations: Hanceville, AL
O20130903000624 AL Part A Provider - Rural Health Clinic 7315188281 Practice locations: Hanceville, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033554357. Details of each certification follow.

Rural health clinic certification: CCN 018907

Legal name
SOUTHVIEW MEDICAL CLINIC LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 1, 2013
Last certification
Dec 1, 2013
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Apr 30, 2013 in AL
Enrollment address
307 Main Street SW
Hanceville, AL 35077-4700

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2059615Southview Medical Clinic LLC307 Main Street SW, Hanceville, AL 35077Certificate of waiverMay 27, 2027

National Provider Directory

National Provider Directory

Locations

222 Arkadelphia Rd NE
Hanceville, AL 35077
Phone (256) 352-4767

307 Main St NW
Hanceville, AL 35077
Phone (256) 352-4767

307 Main St SW
Hanceville, AL 35077
Phone (256) 352-0188

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Muhammad Ata Individual 5% Or Greater Direct Ownership Interest Apr 30, 2013
W-2 Managing Employee Apr 30, 2013

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Muhammad Ejaz Ata
    • Internal Medicine Physician
    • Pisgah, AL
    • NPI 1023112307

    5% Or Greater Direct Ownership Interest, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1367280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626393600000",
    "number": "1033554357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 MAIN ST SW",
            "city": "HANCEVILLE",
            "state": "AL",
            "postal_code": "350775476",
            "telephone_number": "256-352-4767",
            "fax_number": "256-352-4797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 MAIN ST SW",
            "city": "HANCEVILLE",
            "state": "AL",
            "postal_code": "350775476",
            "telephone_number": "256-352-4767",
            "fax_number": "256-352-4797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHVIEW MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-30",
        "last_updated": "2021-07-16",
        "certification_date": "2021-07-16",
        "status": "A",
        "authorized_official_last_name": "ATA",
        "authorized_official_first_name": "MUHAMMAD",
        "authorized_official_middle_name": "EJAZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-451-1250",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hanceville, AL

Sources for this page

Verify at the official NPI Registry.