Provider Demographics
NPI:1861750267
Name:PMCOA, INC.
Entity type:Organization
Organization Name:PMCOA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:334-202-2680
Mailing Address - Street 1:PO BOX 241467
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-1467
Mailing Address - Country:US
Mailing Address - Phone:334-356-1111
Mailing Address - Fax:334-356-9873
Practice Address - Street 1:3283 MALCOLM DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-8816
Practice Address - Country:US
Practice Address - Phone:334-491-1111
Practice Address - Fax:334-356-9873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LF0000X
AL2338111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1184717472Medicare NSC