PREVENTIVE CARE MEDICAL GROUP, LLC NPI 1871847988

Specialist in Talladega, AL

NPI 1871847988 Organization Specialist CLIA Number 01D2067055 CLIA Certificate of Waiver

About PREVENTIVE CARE MEDICAL GROUP, LLC

Preventive Care Medical Group,llc is a provider established in Talladega, Alabama specializing in specialist. The NPI number of Preventive Care Medical Group,llc is 1871847988 and was assigned on October 2012. The practitioner's primary taxonomy code is 174400000X. The provider is registered as an organization and their NPI record was last updated 9 years ago. Preventive Care Medical Group,llc operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Dr. Anthony Lessa Md (Physician)

The CLIA number of Preventive Care Medical Group,llc is 01D2067055 registered as a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Preventive Care Medical Group,llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1871847988

Provider NamePREVENTIVE CARE MEDICAL GROUP,LLC
Provider Location Address210 NORTH ST W SUITE C TALLADEGA, AL 35160
Provider Mailing Address210 NORTH ST W SUITE C TALLADEGA, AL 35160
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date10-29-2012
Last Update Date10-29-2012


Primary Taxonomy

Taxonomy Code174400000X
ClassificationSpecialist
TypeOther Service Providers
Taxonomy DescriptionAn individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Business Address

PREVENTIVE CARE MEDICAL GROUP,LLC
210 NORTH ST W
SUITE C
TALLADEGA, AL
ZIP 35160
Phone: (256) 362-0066

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Mailing Address

PREVENTIVE CARE MEDICAL GROUP,LLC
210 NORTH ST W
SUITE C
TALLADEGA, AL
ZIP 35160
Phone: (256) 362-0066



Authorized Official

Authorized Official NameDR. ANTHONY LESSA MD
Authorized Official TitlePHYSICIAN
Authorized Official Phone(256) 362-0066

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1871847988 is:

CLIA Number01D2067055
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate of Waiver

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Other Providers at the same location


The following 6 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1265662720LANDMARK NEPHROLOGY & HYPERTENSION CLINIC. P.C
Organization
Clinic/Center (Medical Specialty)210 NORTH ST W SUITE D
TALLADEGA, AL 35160
(256) 283-9760
1407931827PROFESSIONAL APOTHECARY, INC.
Organization
Durable Medical Equipment & Medical Supplies210 NORTH ST W
TALLADEGA, AL 35160
(256) 362-8328
1780055319PREVENTIVE CARE MEDICL GROUP
Organization
Family Medicine210 NORTH ST W SUITE E
TALLADEGA, AL 35160
(256) 362-0066
1619962511PROFESSIONAL APOTHECARY INC.
Organization
Pharmacy210 NORTH ST W
TALLADEGA, AL 35160
(256) 362-8328
1396043881 ANTHONY LESSA MD
Individual
General Practice210 NORTH ST W
TALLADEGA, AL 35160
(256) 362-0066
1982800884TALLADEGA NEPHROLOGY, LLC
Organization
Internal Medicine (Nephrology)210 NORTH ST W
TALLADEGA, AL 35160
(256) 521-1996

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.