Faith Medical Clinic LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

FAITH MEDICAL CLINIC LLC

Practice address

64 McCurdy Ave N
Rainsville, AL 35986-4465

Phone

(256) 638-4411

Fax

(256) 638-9275

NPI assigned

Apr 17, 2020

Last updated

Jan 28, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Angela Reynoso

Title

Office Manager

Phone

(256) 638-4411

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487274650. Details of each certification follow.

• CCN 018958 Rural health clinic · Active · Details

Rural health clinic certification: CCN 018958

Legal name

FAITH MEDICAL CLINIC LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Apr 4, 2022

Last certification

Mar 15, 2022

Ownership / control type

1B

Organization structure

LLCProprietary

Enrollment address

64 McCurdy Ave N
Rainsville, AL 35986-4465

Locations

All disclosed owners & managing parties 1

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

Owners & managing parties with NPI records 1

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

• Paula Henderson, FNP

  • Family Medicine Physician
  • Fort Payne, AL
  • NPI 1912470824

  5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

  CMS ownership

Practitioners 2

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.

• Paula Henderson, FNP

  • Family Medicine Physician
  • Fort Payne, AL
  • NPI 1912470824
  Medicare reassignment Care Compare group NPD
• Deann B Cobble, CRNP

  • Family Nurse Practitioner
  • Rainsville, AL
  • NPI 1427475045
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738022400000",
    "number": "1487274650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 MCCURDY AVE N",
            "city": "RAINSVILLE",
            "state": "AL",
            "postal_code": "359864465",
            "telephone_number": "256-638-4411",
            "fax_number": "256-638-9275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 MCCURDY AVE N",
            "city": "RAINSVILLE",
            "state": "AL",
            "postal_code": "359864465",
            "telephone_number": "256-638-4411",
            "fax_number": "256-638-9275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAITH MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-17",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "REYNOSO",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "256-638-4411"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912470824",
            "state": "AL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Email",
            "affiliation": "N",
            "endpointDescription": "Laptop",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Health",
            "address_1": "64 McCurdy Ave N",
            "city": "Rainsville",
            "state": "AL",
            "country_code": "US",
            "postal_code": "359864465",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Nurse Practitioner in Rainsville, AL
• Providers in Rainsville, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.