NPIMap

Organization Active NPI

Midway Medical Clinic LLC

  • Multi-Specialty Clinic/Center
  • Oneonta, AL
National Provider Identifier
1386984649
Registry record updated Jul 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MIDWAY MEDICAL CLINIC LLC
Practice address
27550 State Highway 75 Ste 105
Oneonta, AL 35121-3204
Phone
(256) 451-1250
NPI assigned
Feb 25, 2013
Last updated
Jul 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2019

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

Authorized official

Name
Mr. Muhammad Ejaz Ata, MDNPI 1023112307
Title
Owner
Phone
(256) 599-7566

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X AL Primary

Addresses

Primary practice location

27550 State Highway 75 Ste 105
Oneonta, AL 35121-3204

Mailing address

PO Box 568
Oneonta, AL 35121-0007
Phone (256) 451-1250

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130429000330 AL Part A Provider - Rural Health Clinic 4688819592 Practice locations: Oneonta, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386984649. Details of each certification follow.

Rural health clinic certification: CCN 018901

Legal name
MIDWAY MEDICAL CLINIC, LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 14, 2013
Last certification
Jun 14, 2013
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
Feb 19, 2013 in AL
Enrollment address
27550 State Highway 75
Ste 105
Oneonta, AL 35121-3204

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
01D2055902Midway Medical Clinic LLC27550 State Highway 75 Suite 105, Oneonta, AL 35121Certificate of waiverMar 18, 2027

National Provider Directory

National Provider Directory

Locations

27550 State Highway 75
Ste 105
Oneonta, AL 35121
Phone (205) 625-4930

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17774/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Muhammad Ata Individual 5% Or Greater Direct Ownership Interest Feb 19, 2013
W-2 Managing Employee Feb 19, 2013
Zaheer a Khan Individual 5% Or Greater Direct Ownership Interest Feb 19, 2012
W-2 Managing Employee Feb 19, 2013

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 11

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": "1361750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563408000000",
    "number": "1386984649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 568",
            "city": "ONEONTA",
            "state": "AL",
            "postal_code": "351210007",
            "telephone_number": "256-451-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27550 STATE HIGHWAY 75 STE 105",
            "city": "ONEONTA",
            "state": "AL",
            "postal_code": "351213204",
            "telephone_number": "256-451-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWAY MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-25",
        "last_updated": "2019-07-18",
        "status": "A",
        "authorized_official_last_name": "ATA",
        "authorized_official_first_name": "MUHAMMAD",
        "authorized_official_middle_name": "EJAZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-599-7566",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "AL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oneonta, AL

Sources for this page

Verify at the official NPI Registry.