NORTHSIDE MEDICAL, INC. (NPI# 1205089372) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1205089372 |
Entity Type | Organization |
Organization Name | NORTHSIDE MEDICAL, INC. |
Practice Address |
211 Greenhill Blvd Nw Fort Payne AL 35967-3755 |
Mailing Address |
Po Box 680047 Fort Payne AL 35968-1601 |
Practice Telephone | 2568459355 |
Mailing Telephone | 2568459355 |
Enumeration Date | 2008-11-02 |
Last Update Date | 2008-11-02 |
Authorized Official Name | DR. ROBERT W. THEAKSTON (PRESIDENT) |
Authorized Official Telephone | 2568459355 |
Authorized Official Credential | M.D. |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
Street Address |
211 GREENHILL BLVD NW |
City | FORT PAYNE |
State | AL |
Zip Code | 35967-3755 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1255374492 | Robert W Theakston | Emergency Medicine | 211 Greenhill Blvd Nw, Fort Payne, AL 35967-3755 | 2006-06-14 |
1578940235 | Patrick Gregory Tatum | Nurse Practitioner | 211 Greenhill Blvd Nw, Fort Payne, AL 35967-3755 | 2015-05-01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073086922 | Ft Payne Careplus, LLC | Clinic/Center | 3000 Gault Ave North, Ft Payne, AL 35967 | 2019-01-03 |
1851739023 | Marlon Chad Williamson | Emergency Medicine | 617 Gault Ave N, Fort Payne, AL 35967 | 2013-06-11 |
1447552401 | Karole Kelley Ohme | Counselor | 216 Gault Avenue N, Relationship Clinic, Fort Payne, AL 35967 | 2010-11-24 |
1720112014 | Dekalb County Mr Board | Case Management | 117 First St Nw, Fort Payne, AL 35967 | 2007-03-16 |
1447275490 | Glynn Whiddon Odom | Nurse Anesthetist, Certified Registered | 200 Medical Center Drive, Fort Payne, AL 35967 | 2006-07-12 |
1477521698 | Michael Ray Parker | Optometrist | 900 Gault Ave S, Fort Payne, AL 35967 | 2006-03-14 |
1144204843 | Dale Ray Stierwalt | Family Medicine | 1618 Gault Ave. N., Fort Payne, AL 35967 | 2005-12-06 |
1417951112 | Barton Drake Ibsen | Physical Therapist | 121 Drinkard Dr, Fort Payne, AL 35967 | 2005-06-09 |
1407363146 | Tyson Scott Rainer | Nurse Practitioner | 1040 Glenn Blvd Sw, Fort Payne, AL 35967 | 2018-01-03 |
1801336599 | Caitlin Kirby | Massage Therapist | 216 Gault Ave N, Fort Payne, AL 35967 | 2017-03-01 |
Find all providers in zip 35967 |
Taxonomy Code | 261QP2300X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Primary Care |
Definition to come... |
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1891316758 | Modern Health Family Care Practice | Clinic/Center | 13000 Cottonwood Rd, Cottonwood, AL 36320-4280 | 2020-05-01 |
1487274650 | Faith Medical Clinic LLC | Clinic/Center | 64 Mccurdy Ave N, Rainsville, AL 35986-4465 | 2020-04-17 |
1386283471 | E A Mccleskey, Do, LLC | Clinic/Center | 103 Intercom Dr Ste B, Madison, AL 35758-2641 | 2020-01-06 |
1568012755 | Watchman's Health PC | Clinic/Center | 1501 7th St Se Ste A, Decatur, AL 35601-3375 | 2019-09-19 |
1184273096 | Spedale Md PC | Clinic/Center | 3113 Wesley Way Ste 1, Dothan, AL 36305-2004 | 2019-09-04 |
1124675459 | Mainstreet Family Care LLC | Clinic/Center | 1500 1st Ave N Unit 3, Birmingham, AL 35203-1866 | 2019-08-21 |
1568016004 | Fenton Chiropractic LLC | Clinic/Center | 301 1st St S, Reform, AL 35481-8013 | 2019-08-01 |
1568967081 | Bernice R Swain Do Pllc | Clinic/Center | 2424 Danville Rd Sw Ste L, Decatur, AL 35603-4219 | 2018-03-27 |
1578088001 | Coastal Health & Wellness | Clinic/Center | 14 Confederate Dr S, Spanish Fort, AL 36527-3062 | 2017-08-05 |
1760918494 | Killen Urgent Care, Inc. | Clinic/Center | 152 J C Mauldin Hwy, Killen, AL 35645-9106 | 2017-05-01 |
Find all providers with the same taxonomy |
City | FORT PAYNE |
Zip Code | 35967 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.