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CUSTOM FAMILY CARE LLC NPI 1053839811


NPI Information

NPI: 1053839811
Provider Name: CUSTOM FAMILY CARE, LLC

Doing Business As: CUSTOM FAMILY CARE

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 01D2146280

Address:
279 HUGHES RD
MADISON, AL
ZIP 35758
Phone: (256) 289-1733
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CUSTOM FAMILY CARE, LLC is a family medicine in Madison, AL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. CUSTOM FAMILY CARE, LLC NPI is 1053839811. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Custom Family Care.

The provider's business location address is:

279 HUGHES RD
MADISON, AL
ZIP 35758-142
Phone: (256) 289-1733

The provider's authorized official is Ivan Pivovarov .
The authorized official title is President and has the following contact phone number (256) 325-0480.

The CLIA number assigned to this NPI record is 01D2146280 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/31/2017 and was last updated on 6/2/2021.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineYes
2261QU0200XClinic/CenterUrgent CareNo

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: 4/28/2024

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