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UNITED DOCTORS FAMILY MEDICAL CENTER - ALTOONA
NPI 1104456920
Internal Medicine in Altoona, AL

Active since January 21, 2020CLIA Certified · 3 labs
7130 6TH AVE, ALTOONA, AL 35952(205) 589-1092(205) 589-1096 Get Directions Write a Review

NPPES record last updated: April 9, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 9, 2022, Sep 16, 2020, Jan 24, 2020 (3 updates tracked since 2020).

About United Doctors Family Medical Center - Altoona NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

UNITED DOCTORS FAMILY MEDICAL CENTER - ALTOONA (NPI 1104456920) is a healthcare organization registered as an internal medicine in Altoona, Alabama and active in the NPI registry since January 2020. The organization holds 3 active CLIA laboratory certificates and lists Enrico D Gaspar, Owner, as its authorized official.

NPPES Registry Identity

NPI1104456920
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameSOUTHERN DIVINE FAMILY MEDICAL CENTER LLC
Location Address7130 6TH AVEAltoona, AL 35952-9052
Mailing AddressPo Box 35Altoona, AL 35952-0035 · (205) 589-1092 · Fax (205) 589-1096
Phone(205) 589-1092
Fax(205) 589-1096
Organization SubpartNo
Authorized OfficialEnrico D GasparOwner · (256) 840-8181
Enumeration DateJanuary 21, 2020
Last NPPES UpdateApril 9, 20223 updates tracked since enumeration
NPPES CertifiedApril 9, 2022
✔ NPI 1104456920 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedNurse Practitioner · Acute CareTaxonomy 363LA2100X
Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
7130 6TH AVE, Altoona, AL 35952
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Other Names 1

Doing Business AsUnited Doctors Family Medical Center - Altoona

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

United Doctors Family Medical Center - Altoona is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to United Doctors Family Medical Center - Altoona, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Ashley Bozarth, CRNP
Nurse Practitioner
NPI 1184439184
7130 6TH AVE
Altoona, AL 35952
(205) 589-1092
✔ PECOS0.2 mi
Amanda Willis, CRNP
Nurse Practitioner
NPI 1508559956
180 MEDICAL ST
Altoona, AL 35952
(205) 386-4341
✔ PECOS✔ Accepts Medicare7.4 mi
Enrico Gaspar, M.D.
Internal Medicine
NPI 1497740492
2986 US HIGHWAY 431
Boaz, AL 35957
(256) 840-8181
✔ PECOS17 mi
Cody Jarmon, CRNP
Nurse Practitioner
NPI 1497230478
2986 US HIGHWAY 431
Boaz, AL 35957
(256) 840-8181
✔ PECOS17 mi
Patrick Sellers, CRNP
Nurse Practitioner
NPI 1205342268
2986 US HIGHWAY 431
Boaz, AL 35957
(256) 840-8181
✔ PECOS17 mi
Alvin Tenchavez, M.D.
Internal Medicine
NPI 1225023211
2986 US HIGHWAY 431
Boaz, AL 35957
(256) 840-8181
✔ PECOS✔ Accepts Medicare17 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 01D2167843

United Doctors Family Medical Center - Altoona Southern Divine, LLC · Altoona, AL
Active · expires Jun 16, 2027
CLIA Number01D2167843
Laboratory TypePhysician Office
Certificate Effective DateJune 17, 2025
Certificate Expiration DateJune 16, 2027
Laboratory DirectorEnrico D. Gaspar
Laboratory Phone(205) 589-1092
Laboratory LocationUnited Doctors Family Medical Center - Altoona Southern Divine, LLC7130 6th Ave, Altoona, AL 35952
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 01D2092216

United Doctors Family Medical Center · Boaz, AL
Active · expires Mar 1, 2027
CLIA Number01D2092216
Laboratory TypePhysician Office
Certificate Effective DateMarch 2, 2025
Certificate Expiration DateMarch 1, 2027
Laboratory DirectorEnrico D. Gaspar MD
Laboratory Phone(256) 840-8181
Laboratory LocationUnited Doctors Family Medical Center2986 Us Hwy 431, Boaz, AL 35957
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 01D2183412

United Doctors Family Medical Center Snead · Snead, AL
Active · expires May 4, 2028
CLIA Number01D2183412
Laboratory TypePhysician Office
Certificate Effective DateMay 5, 2026
Certificate Expiration DateMay 4, 2028
Laboratory DirectorEnrico D. Gaspar
Laboratory Phone(205) 589-1092
Laboratory LocationUnited Doctors Family Medical Center Snead180 Medical Street, Snead, AL 35952
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Divine Family Medical Center LLC's NPI number?

The NPI number for Southern Divine Family Medical Center LLC is 1104456920. It was assigned to this organization in the NPPES registry on January 21, 2020. The provider is doing business as United Doctors Family Medical Center - Altoona.

Where is Southern Divine Family Medical Center LLC located?

Southern Divine Family Medical Center LLC is located at 7130 6th Ave, Altoona, AL 35952. The listed phone number is (205) 589-1092.

What is Southern Divine Family Medical Center LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Southern Divine Family Medical Center LLC enrolled in Medicare?

Yes. Southern Divine Family Medical Center LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southern Divine Family Medical Center LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to Southern Divine Family Medical Center LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (4) and Internal Medicine (2). Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Southern Divine Family Medical Center LLC hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Southern Divine Family Medical Center LLC was last updated on April 9, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.