Basic Information
Provider Information
NPI: 1861750267
EntityType: 2
ReplacementNPI:  
OrganizationName: PMCOA, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: HEALTH STAR
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 241467
Address2:  
City: MONTGOMERY
State: AL
PostalCode: 361241467
CountryCode: US
TelephoneNumber: 3343561111
FaxNumber: 3343569873
Practice Location
Address1: 3283 MALCOLM DR
Address2:  
City: MONTGOMERY
State: AL
PostalCode: 361168816
CountryCode: US
TelephoneNumber: 3344911111
FaxNumber: 3343569873
Other Information
ProviderEnumerationDate: 04/24/2012
LastUpdateDate: 11/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: COBB
AuthorizedOfficialFirstName: CANDICE
AuthorizedOfficialMiddleName: WARREN
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 3342022680
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: DC
NPICertificationDate: 11/10/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
111N00000X2338ALY193200000X MULTI-SPECIALTY GROUPChiropractic ProvidersChiropractor 

No ID Information.


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