| Heritage Family Medicine | |
|
12205 County Line Rd Suite B Madison AL 35758-7719 | |
| (256) 990-8446 | |
| (256) 461-0393 |
| Full Name | Heritage Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 12205 County Line Rd, Madison, Alabama |
| Authorized Official Name and Position | Anthony G Mancuso (CFO) |
| Authorized Official Contact | 2569908446 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heritage Family Medicine Po Box 617 Madison AL 35758-0617 Ph: (256) 990-8446 | Heritage Family Medicine 12205 County Line Rd Suite B Madison AL 35758-7719 Ph: (256) 990-8446 |
| NPI Number | 1114141744 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 12/07/2018 |
| Medicare PECOS PAC ID | 9931382116 |
|---|---|
| Medicare Enrollment ID | O20110325000020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114141744 | NPI | - | NPPES |
| 529910550 | Medicaid | AL | |
| 051506404 | Other | AL | MANCUSO BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 00015990 (Alabama) | Primary |
| Provider Name | Dawn Bridges Mancuso |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114935756 PECOS PAC ID: 9335052927 Enrollment ID: I20031110000621 |
| Provider Name | Bethany M Gilbert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235122672 PECOS PAC ID: 2668423898 Enrollment ID: I20050204000696 |
| Provider Name | Cindy M Mcadams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306829759 PECOS PAC ID: 1850330044 Enrollment ID: I20050427000747 |
| Provider Name | Katy E Shrode |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487991568 PECOS PAC ID: 1850536319 Enrollment ID: I20130404000119 |
Dr. Sunita Puri Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8075 Madison Blvd Ste 106, Madison, AL 35758 Phone: 256-464-6004 Fax: 256-464-0403 | |
Custom Family Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 279 Hughes Rd, Madison, AL 35758 Phone: 256-289-1733 | |
Caswall C Harrigan Physician Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Madison Medical Plaza 540 Hughes Road, Suite 14, Madison, AL 35758 Phone: 256-426-0802 | |
Tennessee Valley Internal Medicine, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3809 Sullivan St, Suite 7, Madison, AL 35758 Phone: 256-428-1096 Fax: 256-428-1097 | |
American Family Care Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7559 Hwy 72 W, Madison, AL 35758 Phone: 256-562-0850 Fax: 256-562-0854 | |
Madison Family Health, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3776 Sullivan St, Suite D, Madison, AL 35758 Phone: 256-325-0302 Fax: 256-325-0391 |