Organization Active NPI

The Village Medical Clinic

  • Specialist
  • Huntsville, AL
National Provider Identifier
1114968583
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
THE VILLAGE MEDICAL CLINIC
Practice address
2103 Drake Ave SW
Huntsville, AL 35805-5107
Phone
(256) 881-1616
Fax
(256) 882-5322
NPI assigned
Jun 9, 2006
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
Mrs. Lisa Brabon, CPC, CMOM
Title
Office Manager
Phone
(256) 881-1616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

2103 Drake Ave SW
Huntsville, AL 35805-5107

Mailing address

2103 Drake Ave SW
Huntsville, AL 35805-5107
Phone (256) 881-1616

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051118000705 AL Part B Supplier - Clinic/Group Practice 7719906718 Receives reassigned benefits from 2 practitioners
Practice locations: Huntsville, AL

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
01D0982367Village Medical Clinic PC2103 Drake Ave SW, Huntsville, AL 35805Provider-performed microscopyJan 22, 2027

National Provider Directory

National Provider Directory

Locations

2103 Drake Ave SW
Huntsville, AL 35805
Phone (256) 881-1616

4800 Whitesburg Dr SW
Ste 2
Huntsville, AL 35802
Phone (256) 881-1616

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114968583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 DRAKE AVE SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358055107",
            "telephone_number": "256-881-1616",
            "fax_number": "256-882-5322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 DRAKE AVE SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358055107",
            "telephone_number": "256-881-1616",
            "fax_number": "256-882-5322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE VILLAGE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRABON",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "256-881-1616",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPC, CMOM"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, 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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.