Provider Demographics
NPI:1316103237
Name:WILLS VALLEY FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:WILLS VALLEY FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:H
Authorized Official - Last Name:KOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-524-3090
Mailing Address - Street 1:13280 COUNTY ROAD 51
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35961-4174
Mailing Address - Country:US
Mailing Address - Phone:256-524-3090
Mailing Address - Fax:256-524-2885
Practice Address - Street 1:13280 COUNTY ROAD 51
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35961-4174
Practice Address - Country:US
Practice Address - Phone:256-524-3090
Practice Address - Fax:256-524-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1316103237Medicaid
AL510I080356OtherMEDICARE PTAN