NPIMap

Organization Active NPI

Creekside Family Practice

  • Family Medicine Physician
  • Huntsville, AL
National Provider Identifier
1801097597
Registry record updated Jul 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CREEKSIDE FAMILY PRACTICE
Practice address
810 Franklin St SE
Huntsville, AL 35801-4310
Phone
(256) 551-6503
Fax
(256) 533-8935
NPI assigned
May 30, 2007
Last updated
Jul 12, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2007

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

Authorized official

Name
Dr. Claude L Kinzer, M.D.NPI 1518921220
Title
President
Phone
(256) 551-6503

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

810 Franklin St SE
Huntsville, AL 35801-4310

Mailing address

810 Franklin St SE
Huntsville, AL 35801-4310
Phone (256) 551-6503

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040625000166 AL Part B Supplier - Clinic/Group Practice 9133105786 Receives reassigned benefits from 6 practitioners
Practice locations: Huntsville, AL

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0302960Creekside Family Practice PC810 Franklin Street Suite B, Huntsville, AL 35801AccreditationDec 22, 2027

National Provider Directory

National Provider Directory

Locations

810 Franklin St SE
Huntsville, AL 35801
Phone (256) 533-7676

810 Franklin St SE
#B
Huntsville, AL 35801
Phone (256) 551-6503

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184198400000",
    "number": "1801097597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 FRANKLIN ST SE",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358014310",
            "telephone_number": "256-551-6503",
            "fax_number": "256-533-8935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 FRANKLIN ST SE",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358014310",
            "telephone_number": "256-551-6503",
            "fax_number": "256-533-8935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2007-07-12",
        "status": "A",
        "authorized_official_last_name": "KINZER",
        "authorized_official_first_name": "CLAUDE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "256-551-6503",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.