Provider Demographics
NPI:1104550961
Name:ALLEGRA HEALTHCARE
Entity type:Organization
Organization Name:ALLEGRA HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MCMURRY
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:205-454-3191
Mailing Address - Street 1:4804 HIGHWAY 69 N
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-2035
Mailing Address - Country:US
Mailing Address - Phone:205-556-5634
Mailing Address - Fax:205-556-5634
Practice Address - Street 1:4804 HIGHWAY 69 N
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-2035
Practice Address - Country:US
Practice Address - Phone:205-556-5634
Practice Address - Fax:205-556-5634
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLEGRA HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-15
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty