Basic Information
| Provider Information | |||||||||
| NPI: | 1306831243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLY | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2705 | ||||||||
| Address2: | STE 220 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358042705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568016048 | ||||||||
| FaxNumber: | 2568016218 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 SIVLEY RD SW | ||||||||
| Address2: | SUITE 620 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358015134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562654600 | ||||||||
| FaxNumber: | 2562654651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 01/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | 00019355 | AL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 009955755 | 05 | AL | MEDICAID | 2230930 | 01 | AL | FIRST HEALTH PROVIDER # | OTHER | P00603054 | 01 | AL | RR MEDICARE | OTHER | 515-35231 | 01 | AL | BCBS OF AL | OTHER | 5492768 | 01 | AL | CCN PROVIDER NUMBER | OTHER | 510-50070 | 01 | AL | BCBS OF ALABAMA | OTHER | 515-19377 | 01 | AL | BCBS OF AL PROVIDER # | OTHER | 528701110 | 05 | AL | MEDICAID | DD6388 | 01 | AL | RAILROAD MCARE PROV. # | OTHER | G38565 | 01 | AL | VIVA HEALTH PROVIDER # | OTHER | 009941926 | 05 | AL | MEDICAID | CA0084 | 01 | AL | RR MEDICARE | OTHER | 7008083 | 01 | AL | AETNA PROVIDER NUMBER | OTHER |