Provider Demographics
NPI:1144627126
Name:RICKY TUBBS, LLC
Entity type:Organization
Organization Name:RICKY TUBBS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:TUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-368-1509
Mailing Address - Street 1:1122 SHADY LANE CIR
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2941
Mailing Address - Country:US
Mailing Address - Phone:256-640-0416
Mailing Address - Fax:256-268-7152
Practice Address - Street 1:613 MARTIN ST N
Practice Address - Street 2:SUITE 300
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-1333
Practice Address - Country:US
Practice Address - Phone:256-368-1509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty