NORTHSIDE MEDICAL INC. NPI 1205089372

NPI Information

  • NPI: 1205089372
  • Provider Name: NORTHSIDE MEDICAL, INC.
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • CLIA Number: 01D1105179
  • Address: 211 GREENHILL BLVD NW
    FORT PAYNE, AL
    ZIP 35967
  • Phone: (256) 845-9355

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NPI Details

NORTHSIDE MEDICAL, INC. is a primary care clinic center in Fort Payne, AL. NORTHSIDE MEDICAL, INC. NPI is 1205089372. The provider is registered as an organization entity type.

The provider's business location address is:

211 GREENHILL BLVD NW
FORT PAYNE, AL
ZIP 35967-755
Phone: (256) 845-9355

The provider's authorized official is Robert W. Theakston .
The authorized official title is President and has the following contact phone number (256) 845-9355.

The CLIA number assigned to this NPI record is 01D1105179 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/2/2008 and was last updated on 11/2/2008.

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
1261QP2300XClinic/CenterPrimary CareYes

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: 11/21/2025

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