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
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
08/31/2017
Last updated
06/02/2021
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