Provider Demographics
NPI:1104907781
Name:SYLACAUGA OBSTETRICS AND PRIMARY CARE, LLC
Entity type:Organization
Organization Name:SYLACAUGA OBSTETRICS AND PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-249-5888
Mailing Address - Street 1:209 W SPRING ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2973
Mailing Address - Country:US
Mailing Address - Phone:256-249-5888
Mailing Address - Fax:256-249-5040
Practice Address - Street 1:209 W SPRING ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2973
Practice Address - Country:US
Practice Address - Phone:256-249-5888
Practice Address - Fax:256-249-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center