Provider Demographics
NPI:1548724297
Name:WECARE FAMILY PRACTICE CLINIC LLC
Entity type:Organization
Organization Name:WECARE FAMILY PRACTICE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REMONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-764-5162
Mailing Address - Street 1:6521 HIGHWAY 69 S STE M
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-6498
Mailing Address - Country:US
Mailing Address - Phone:205-764-5162
Mailing Address - Fax:
Practice Address - Street 1:6521 HIGHWAY 69 S STE M
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-6498
Practice Address - Country:US
Practice Address - Phone:205-764-5162
Practice Address - Fax:205-764-5187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty