Provider Demographics
NPI:1104459411
Name:MEDICAL CENTER PLUS LLC
Entity type:Organization
Organization Name:MEDICAL CENTER PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PEACOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-501-8867
Mailing Address - Street 1:1685 E UNIVERSITY DR STE E
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5217
Mailing Address - Country:US
Mailing Address - Phone:334-501-8867
Mailing Address - Fax:
Practice Address - Street 1:1685 E UNIVERSITY DR STE E
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-5217
Practice Address - Country:US
Practice Address - Phone:334-501-8867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty