NPIMap

Organization Active NPI

Complete Health & Wellness of Al, Inc

  • Family Medicine Physician
  • Tuscaloosa, AL
National Provider Identifier
1649569963
Registry record updated Apr 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
27746 Issued in AL
Legal business name
COMPLETE HEALTH & WELLNESS OF AL, INC
Practice address
819 Mimosa Park Rd
Suite C
Tuscaloosa, AL 35405-4839
Phone
(205) 343-7743
Fax
(205) 752-7513
NPI assigned
Apr 7, 2011
Last updated
Apr 11, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2011

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

Authorized official

Name
Brent Alan TidwellNPI 1154438802
Title
Pres
Phone
(205) 343-7743

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1-079816 AL
Family Medicine Physician 207Q00000X 27746 AL Primary

Addresses

Primary practice location

819 Mimosa Park Rd
Suite C
Tuscaloosa, AL 35405-4839

Mailing address

819 Mimosa Park Road
Suite C
Tuscaloosa, AL 35405
Phone (205) 343-7743

National Provider Directory

National Provider Directory

Locations

819 Mimosa Park Rd
Ste C
Tuscaloosa, AL 35405
Phone (205) 343-7743

Practitioners & affiliated clinicians

Practitioners 3

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": "1302134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302480000000",
    "number": "1649569963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 MIMOSA PARK ROAD",
            "address_2": "SUITE C",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "35405",
            "telephone_number": "205-343-7743",
            "fax_number": "205-752-7513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 MIMOSA PARK RD",
            "address_2": "SUITE C",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354054839",
            "telephone_number": "205-343-7743",
            "fax_number": "205-752-7513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE HEALTH & WELLNESS OF AL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-07",
        "last_updated": "2011-04-11",
        "status": "A",
        "authorized_official_last_name": "TIDWELL",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "205-343-7743"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-079816",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "27746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.