Provider Demographics
NPI:1427235381
Name:SOUTHEASTERN INDUSTRIAL & FAMILY MEDICINE ASSOC., LLC
Entity type:Organization
Organization Name:SOUTHEASTERN INDUSTRIAL & FAMILY MEDICINE ASSOC., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-261-4445
Mailing Address - Street 1:1600 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1542
Mailing Address - Country:US
Mailing Address - Phone:334-261-4445
Mailing Address - Fax:334-261-4448
Practice Address - Street 1:1600 FOREST AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1542
Practice Address - Country:US
Practice Address - Phone:334-261-4445
Practice Address - Fax:334-261-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI971Medicare PIN
ALH07438Medicare UPIN