# CUSTOM FAMILY CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Custom Family Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053839811
- **Authorized official:** IVAN PIVOVAROV MD (PRESIDENT)
- **Authorized official phone:** (256) 325-0480

## Contact information

- **Practice address:** 279 HUGHES RD, MADISON, AL 35758-1142
- **Practice address phone:** (256) 289-1733
- **Mailing address:** 279 HUGHES RD, MADISON, AL 35758-1142

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/31/2017
- **Last updated:** 06/02/2021