| Gulf Family Medical Llc | |
|
511 State Highway 59 N Summerdale AL 36580-3686 | |
| (256) 550-1415 | |
| Not Available |
| Full Name | Gulf Family Medical Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 511 State Highway 59 N, Summerdale, Alabama |
| Authorized Official Name and Position | Amanda Maddox (BUSINESS OWNER) |
| Authorized Official Contact | 2519899400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Family Medical Llc Po Box 703 Summerdale AL 36580-0703 Ph: () - | Gulf Family Medical Llc 511 State Highway 59 N Summerdale AL 36580-3686 Ph: (256) 550-1415 |
| NPI Number | 1285374470 |
|---|---|
| Provider Enumeration Date | 03/29/2022 |
| Last Update Date | 10/17/2022 |
| Medicare PECOS PAC ID | 5799162723 |
|---|---|
| Medicare Enrollment ID | O20220513000575 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285374470 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Amanda Maddox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073109708 PECOS PAC ID: 8729494174 Enrollment ID: I20210309001995 |
| Provider Name | Ethan S. Sellers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871080986 PECOS PAC ID: 4284035031 Enrollment ID: I20210630001771 |
Summerdale Family Medicine, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 Highway 59 N, Summerdale, AL 36580 Phone: 251-989-9400 Fax: 251-989-2090 |