Chilton Family Medicine, P.C.
Organization Active NPI Rural Health Clinic/Center · Thorsby, AL
NPI 1073389003 · NPPES record last updated Nov 30, 2023
Key facts
- NPI
- 1073389003
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- CHILTON FAMILY MEDICINE, P.C.
- Practice address
- 14 Minnesota Ave
Thorsby, AL 35171 - Phone
- (256) 280-1010
- NPI assigned
- Nov 30, 2023
- Organization subpart
- No
Authorized official
- Name
- Jeffrey F Price
- Title
- Owner
- Phone
- (205) 280-1010
Owners & managing parties with NPI records 1
-
Jeffrey F Price, M.D.
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 1
Practitioners 6
-
Ashlee Carlo, CRNP
-
Jeffrey F Price, M.D.
-
Haley Nichole Bice, CRNP
-
April Nicole Jones, CRNP
-
Shannon Miller, CRNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D2292598 | Chilton Family Medicine PC | Certificate of waiver | Oct 25, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Rural health clinic certification: CCN 018974
- Legal name
- CHILTON FAMILY MEDICINE, P.C.
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 8, 2024
- Last certification
- Mar 15, 2024
- Ownership / control type
- Non-profit – church related
- Organization structure
- Corporation · Proprietary
- Incorporated
- Oct 5, 1999 in AL
- Enrollment address
- 14 Minnesota Ave
Thorsby, AL 35171
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Jeffrey F Price |
5% Or Greater Direct Ownership Interest |
Nov 5, 1999 | 100% |
| Brooke Lewis |
W-2 Managing Employee |
Dec 6, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231222000216 | AL | Part a Provider - Rural Health Clinic | 8426077199 | Practice locations: Thorsby, AL |
National Provider Directory
- Tax ID family
- Chilton Family Medicine PC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
14 Minnesota Ave
Thorsby, AL 35171
Mailing address
107 Health Center Dr
Clanton, AL 35045-2344
Phone (205) 280-1010
Other providers in Thorsby, AL
- Alabama Family Resource Center, PC
- Frances A Breslin
- Jessica Clare Broussard
- Josephine Brown
- Cenrtal Alabama Medical Associates
- Clanton Hospital LLC
- G Teal Dick
- Claud Griffin Hornsby
- Keela Ray
- Southeastern Med Consultants, LLC.
All providers in Thorsby, AL · Rural Health Clinic/Center in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.