NPIMap

Organization Active NPI

Family Medicine of Tuscaloosa, LLC

  • Family Medicine Physician
  • Tuscaloosa, AL
National Provider Identifier
1104126739
Registry record updated Mar 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
24343 Issued in AL
Legal business name
FAMILY MEDICINE OF TUSCALOOSA, LLC
Practice address
100 Towncenter Blvd
Suite 300
Tuscaloosa, AL 35406-1833
Phone
(205) 464-4971
Fax
(205) 343-7425
NPI assigned
Oct 29, 2010
Last updated
Mar 7, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2012

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

Authorized official

Name
Shannon Amman
Title
Manager
Phone
(205) 464-4971

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 24343 AL Primary

Addresses

Primary practice location

100 Towncenter Blvd
Suite 300
Tuscaloosa, AL 35406-1833

Mailing address

100 Towncenter Blvd
Suite 300
Tuscaloosa, AL 35406-1833
Phone (205) 464-4971

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110616000006 AL Part B Supplier - Clinic/Group Practice 7315124583 Receives reassigned benefits from 1 practitioner
Practice locations: Tuscaloosa, AL

National Provider Directory

National Provider Directory

Locations

1325 McFarland Blvd
Ste 204
Northport, AL 35476
Phone (205) 462-3334

100 Towncenter Blvd
Ste 112
Tuscaloosa, AL 35406
Phone (205) 462-3334

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1288310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331078400000",
    "number": "1104126739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 TOWNCENTER BLVD",
            "address_2": "SUITE 300",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354061833",
            "telephone_number": "205-464-4971",
            "fax_number": "205-343-7425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 TOWNCENTER BLVD",
            "address_2": "SUITE 300",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354061833",
            "telephone_number": "205-464-4971",
            "fax_number": "205-343-7425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE OF TUSCALOOSA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-29",
        "last_updated": "2012-03-07",
        "status": "A",
        "authorized_official_last_name": "AMMAN",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "205-464-4971"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "24343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2012; 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.