NPIMap

Organization Active NPI

Coosa Family Care LLC

  • Primary Care Clinic/Center
  • Rainbow City, AL
National Provider Identifier
1578113221
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
COOSA FAMILY CARE LLC
Practice address
310 W Grand Ave
Rainbow City, AL 35906
Phone
(256) 459-5132
Fax
(256) 459-5179
NPI assigned
Sep 15, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2022

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

Authorized official

Name
Kristopher Holder
Title
Owner/Manager
Phone
(256) 459-5132

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

310 W Grand Ave
Rainbow City, AL 35906

Mailing address

310 W Grand Ave
Rainbow City, AL 35906
Phone (256) 459-5132

Other practice location 1

1024 1st Ave
Gadsden, AL 35901-3544
Phone (256) 543-7406

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191114000003 AL Part B Supplier - Clinic/Group Practice 8325470271 Receives reassigned benefits from 6 practitioners
Practice locations: Rainbow City, AL

National Provider Directory

National Provider Directory
Tax ID family
Coosa Family Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

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": "1568505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667174400000",
    "number": "1578113221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W GRAND AVE",
            "city": "RAINBOW CITY",
            "state": "AL",
            "postal_code": "35906",
            "telephone_number": "256-459-5132",
            "fax_number": "256-543-1661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W GRAND AVE",
            "city": "RAINBOW CITY",
            "state": "AL",
            "postal_code": "35906",
            "telephone_number": "256-459-5132",
            "fax_number": "256-459-5179"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1024 1st Ave",
            "address_purpose": "LOCATION",
            "city": "Gadsden",
            "state": "AL",
            "postal_code": "359013544",
            "country_code": "US",
            "telephone_number": "256-543-7406",
            "fax_number": "256-543-1661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COOSA FAMILY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-15",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A",
        "authorized_official_last_name": "HOLDER",
        "authorized_official_first_name": "KRISTOPHER",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "256-459-5132"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rainbow City, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; 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.