Extended Family Medical Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EXTENDED FAMILY MEDICAL CLINIC

Practice address

108 N Catherine St
Suite a
Mobile, AL 36604-1304

Phone

(251) 438-7170

Fax

(251) 438-7173

NPI assigned

Feb 14, 2007

Organization subpart

No

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

Authorized official

Name

Angelia Deniese Blackmon, CRNP

Title

Medical Director

Phone

(251) 438-7170

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20822/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742342400000",
    "number": "1720121395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 N CATHERINE ST",
            "address_2": "SUITE A",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366041304",
            "telephone_number": "251-438-7170",
            "fax_number": "251-438-7173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 N CATHERINE ST",
            "address_2": "SUITE A",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366041304",
            "telephone_number": "251-438-7170",
            "fax_number": "251-438-7173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDED FAMILY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A",
        "authorized_official_last_name": "BLACKMON",
        "authorized_official_first_name": "ANGELIA",
        "authorized_official_middle_name": "DENIESE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "251-438-7170",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AL",
            "license": "1-073404",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Mobile, AL
• Providers in Mobile, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.