NPIMap

Organization Active NPI

Physical Express

  • Family Medicine Physician
  • Millbrook, AL
National Provider Identifier
1043362734
Registry record updated Mar 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PHYSICAL EXPRESS
Practice address
4081 Alabama Hwy 14
Millbrook, AL 36054
Phone
(334) 285-3222
Fax
(334) 285-6555
NPI assigned
Jan 16, 2007
Last updated
Mar 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2025

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

Authorized official

Name
Mrs. Jade Lane
Title
Credentialing Manager
Phone
(334) 567-4311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4081 Alabama Hwy 14
Millbrook, AL 36054

Mailing address

PO Box 688
Millbrook, AL 36054-0014
Phone (334) 285-3222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050720000998 AL Part B Supplier - Clinic/Group Practice 3476531039 Receives reassigned benefits from 126 practitioners
Practice locations: Millbrook, AL

National Provider Directory

National Provider Directory

Locations

3769 Highway 14
Millbrook, AL 36054
Phone (334) 285-3222

4081 Highway 14
Millbrook, AL 36054
Phone (334) 285-3222

Practitioners & affiliated clinicians

Practitioners 129

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 129

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742428800000",
    "number": "1043362734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 688",
            "city": "MILLBROOK",
            "state": "AL",
            "postal_code": "360540014",
            "telephone_number": "334-285-3222",
            "fax_number": "334-285-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4081 ALABAMA HWY 14",
            "city": "MILLBROOK",
            "state": "AL",
            "postal_code": "36054",
            "telephone_number": "334-285-3222",
            "fax_number": "334-285-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL EXPRESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "JADE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "334-567-4311",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millbrook, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.