BEAVERTON FAMILY MEDICINE LLC NPI 1578240511

NPI Information

NPI: 1578240511
Provider Name: BEAVERTON FAMILY MEDICINE LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 01D2292578

Address:
12815 HIGHWAY 278
BEAVERTON, AL
ZIP 35544
Phone: (205) 606-1200
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BEAVERTON FAMILY MEDICINE LLC is a family nurse practitioner in Beaverton, AL. BEAVERTON FAMILY MEDICINE LLC NPI is 1578240511. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

12815 HIGHWAY 278
BEAVERTON, AL
ZIP 35544-954
Phone: (205) 606-1200

The provider's authorized official is Michael Ethan Butler .
The authorized official title is Practice Manager and has the following contact phone number (256) 590-4137.

The CLIA number assigned to this NPI record is 01D2292578 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/30/2023 and was last updated on 7/14/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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