Deborah R Tisdale (NPI# 1013081249, PAC ID# 8729079512) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is EMERGENCY MEDICINE.
| Nation Provider ID (NPI) | 1013081249 |
| PAC ID by PECOS | 8729079512 |
| Professional Enrollment ID | I20040520000735 |
| Full Name | Deborah R Tisdale |
| Organization Legal Name | EVERGREEN MEDICAL CENTER LLC |
| Address |
106 Edwina St Evergreen AL 36401-3319 |
| Phone Number | 2515784300 |
| Gender | F |
| Credential | MD |
| Graduation Year | 1985 |
| Primary Specialty | EMERGENCY MEDICINE |
| Secondary Specialties | FAMILY PRACTICE |
| Group Practice PAC ID | 6305942145 |
| Number of Group Practice Members | 2 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 010091 | GROVE HILL MEMORIAL HOSPITAL |
| 010148 | EVERGREEN MEDICAL CENTER |
| 010099 | D W MCMILLAN MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 106 Edwina St, Evergreen, AL 36401-3319 | 2515784300 | EVERGREEN MEDICAL CENTER LLC |
| Organization Legal Name | EVERGREEN MEDICAL CENTER LLC |
| Physicians | 1 |
| Street Address |
106 EDWINA ST |
| City | EVERGREEN |
| State | AL |
| Zip | 36401-3319 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jessica Pierce | Nurse Practitioner | Mark A Roberts Md PC | 106 Edwina St, Evergreen, AL 36401-3319 |
| Mark A Roberts | Family Medicine | Mark A Roberts Md PC | 106 Edwina St, Evergreen, AL 36401-3319 |
| William R Farmer Iii | Internal Medicine | 106 Edwina St, Evergreen, AL 36401-3319 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Joshua C. Walsh | Physical Therapy | Encore Rehabilitation Inc | 124 Edwina St, Evergreen, AL 36401-2847 |
| Hector L Salemi-castro | Internal Medicine | 420 W Front St, Evergreen, AL 36401-3279 | |
| Stanley Barnes | Family Medicine | 680 W Front St, Evergreen, AL 36401-3285 | |
| Stephen M West | Family Medicine | 680 W Front St, Evergreen, AL 36401-3285 | |
| Joshua T Wing | Nurse Practitioner | Bayside Orthopedic and Rehabilitation Center PC | 100 Lewis St, Evergreen, AL 36401-3317 |
| Helen Scharko | Family Medicine | 102 Edwina St, Evergreen, AL 36401-3319 | |
| Aubrey A Odom | Optometry | 315 S Main St, Evergreen, AL 36401-3330 |
| City | EVERGREEN |
| Zip Code | 36401 |
| Specialty | EMERGENCY MEDICINE |
| City + Specialty | EVERGREEN + EMERGENCY MEDICINE |
Please comment or provide details below to improve the information on Deborah R Tisdale.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.