Montevallo Family Medicine, LLC
Organization Active NPI Family Medicine Physician · Montevallo, AL
NPI 1720009962 · NPPES record last updated Nov 7, 2011
Key facts
- NPI
- 1720009962
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 21192 (AL)
- Legal business name
- MONTEVALLO FAMILY MEDICINE, LLC
- Practice address
- 33 Salem Rd
Suite 1
Montevallo, AL 35115-3586 - Phone
- (205) 665-7991
- Fax
- (205) 665-2913
- NPI assigned
- Jul 22, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Jonathan C. Merkle, M.D.
- Title
- Physician
- Phone
- (205) 665-7991
Practitioners 1
-
Jonathan C. Merkle, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D0300275 | Montevallo Family Medicine LLC | Provider-performed microscopy | Oct 5, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110113000291 | AL | Part B Supplier - Clinic/Group Practice | 5496944092 |
Receives reassigned benefits from 1 practitioner Practice locations: Montevallo, AL |
National Provider Directory
Locations
33 Salem Rd
Ste 1
Montevallo, AL 35115
Phone (205) 665-7991
33 Salem Rd
#1
Montevallo, AL 35115
Phone (205) 665-7991
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 21192 | AL | Yes |
Addresses
Primary practice location
33 Salem Rd
Suite 1
Montevallo, AL 35115-3586
Mailing address
33 Salem Rd
Suite 1
Montevallo, AL 35115-3586
Phone (205) 665-7991
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 529911870 | Medicaid | AL | |
| 51517997 | Medicaid | AL |
Other providers in Montevallo, AL
- Adrienne McCollum-Smit
- Medicine for Less Inc
- Jonathan C. Merkle
- Kimberly Miles
- Michael Scott Miller
- Jaclyn Rose Morlan
- Erica Tyler Morrison
- Mountain Valley Counseling, LLC
- Tina Nelson
- Parker Counseling Services
All providers in Montevallo, AL · Family Medicine Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.