Provider Demographics
NPI:1366861395
Name:FOCUSAL1011, LLC
Entity type:Organization
Organization Name:FOCUSAL1011, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-414-5810
Mailing Address - Street 1:PO BOX 8159
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36689-0159
Mailing Address - Country:US
Mailing Address - Phone:888-414-5810
Mailing Address - Fax:251-414-5809
Practice Address - Street 1:2202 JORDAN RD SW STE 501
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3691
Practice Address - Country:US
Practice Address - Phone:888-414-5810
Practice Address - Fax:251-414-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty