| Physician Professional Fee Component | |
|
101 Sivley Rd Huntsville AL 35801 | |
| (256) 533-8362 | |
| (256) 533-8262 |
| Full Name | Physician Professional Fee Component |
|---|---|
| Speciality | Internal Medicine |
| Location | 101 Sivley Rd, Huntsville, Alabama |
| Authorized Official Name and Position | David A Frederick (CHIEF FINANCIAL DIRECTOR) |
| Authorized Official Contact | 2565338362 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Physician Professional Fee Component Po Box 1028 Huntsville AL 35807 Ph: (256) 533-7064 | Physician Professional Fee Component 101 Sivley Rd Huntsville AL 35801 Ph: (256) 533-8362 |
| NPI Number | 1083643621 |
|---|---|
| Provider Enumeration Date | 07/03/2006 |
| Last Update Date | 07/16/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083643621 | NPI | - | NPPES |
| CH7560 | Other | AL | RAILROAD MEDICARE |
| F956 | Other | AL | BLUE CROSS OF ALABAMA |
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