Organization
EASTSIDE VENTURES, INC.
Active
Parent organization
EASTSIDE VENTURES, INC.
Other names
Cleveland Family Healthcare
Organization subpart
Yes
Provider details
NPI number
Legal business name
EASTSIDE VENTURES, INC.
Authorized official
MRS. VICKI H PARKS CPA (CHIEF ACCOUNTING OFFICER)
(205) 838-3718
Entity
Organization
Contact information
Practice address
6945 COUNTY HIGHWAY 1, CLEVELAND, AL 35049
(205) 625-3667
Mailing address
PO BOX 232, ONEONTA, AL 35121-0004
(205) 625-3667
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529703160
—
AL
01
—
E892
MEDICARE PT B
—
Enumeration date
03/15/2007
Last updated
02/03/2011
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