Organization Active NPI

Imc-Eastern Shore Family Practice LLC

  • Family Medicine Physician
  • Daphne, AL
National Provider Identifier
1235659319
Registry record updated Jul 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
IMC-EASTERN SHORE FAMILY PRACTICE LLC
Practice address
27961 Highway 98
Suite 14
Daphne, AL 36526
Phone
(251) 626-1175
Fax
(251) 626-1507
NPI assigned
Jun 21, 2017
Last updated
Jul 24, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2026

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

Authorized official

Name
Phillip L Cowart
Title
VP Finance
Phone
(251) 435-1361

Specialties & licenses 1

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

Addresses

Primary practice location

27961 Highway 98
Suite 14
Daphne, AL 36526

Mailing address

PO Box 2226
Mobile, AL 36652-2226

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170808000289 AL Part B Supplier - Clinic/Group Practice 7315218450 Receives reassigned benefits from 6 practitioners
Practice locations: Daphne, AL

National Provider Directory

National Provider Directory

Locations

27961 US Highway 98
Ste 14
Daphne, AL 36526
Phone (251) 626-1175

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784851200000",
    "number": "1235659319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2226",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366522226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27961 HIGHWAY 98",
            "address_2": "SUITE 14",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "36526",
            "telephone_number": "251-626-1175",
            "fax_number": "251-626-1507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMC-EASTERN SHORE FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-21",
        "last_updated": "2026-07-24",
        "certification_date": "2026-07-24",
        "status": "A",
        "authorized_official_last_name": "COWART",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "251-435-1361"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daphne, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2026; 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.