Provider Demographics
NPI:1972264323
Name:HUNTSVILLE PRIMARY AND INTEGRATIVE CARE LLC
Entity type:Organization
Organization Name:HUNTSVILLE PRIMARY AND INTEGRATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-539-4000
Mailing Address - Street 1:PO BOX 6756
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35813-0756
Mailing Address - Country:US
Mailing Address - Phone:256-539-4000
Mailing Address - Fax:256-513-4886
Practice Address - Street 1:2021 CLINTON AVE W STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-7111
Practice Address - Country:US
Practice Address - Phone:256-539-4000
Practice Address - Fax:256-513-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty