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Organization
CUSTOM FAMILY CARE, LLC
Active
Organization
CUSTOM FAMILY CARE, LLC
Active
Other names
Custom Family Care
Organization subpart
No
Provider details
NPI number
Authorized official
IVAN PIVOVAROV MD (PRESIDENT)
(256) 325-0480
Entity
Organization
Contact information
Practice address
279 HUGHES RD, MADISON, AL 35758-1142
(256) 289-1733
Mailing address
279 HUGHES RD, MADISON, AL 35758-1142
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
NULL
Other
Enumeration date
08/31/2017
Last updated
06/02/2021
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