Basic Information
| Provider Information | |||||||||
| NPI: | 1265861009 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SETON MEDICAL MANAGEMENT INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PROVIDENCE SARALAND OCC MED | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 RAMBO DR | ||||||||
| Address2: | |||||||||
| City: | SARALAND | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365712147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516752029 | ||||||||
| FaxNumber: | 2516753734 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 RAMBO DR | ||||||||
| Address2: | |||||||||
| City: | SARALAND | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365712147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516752029 | ||||||||
| FaxNumber: | 2516753734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2013 | ||||||||
| LastUpdateDate: | 11/02/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2516338880 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SETON MEDICAL MANAGEMENT INC. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.