Basic Information
| Provider Information | |||||||||
| NPI: | 1326071366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEDSOLE | ||||||||
| FirstName: | RHONDA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROWELL | ||||||||
| OtherFirstName: | RHONDA | ||||||||
| OtherMiddleName: | MICHELE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 2867 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366522867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516908894 | ||||||||
| FaxNumber: | 2515442188 | ||||||||
| Practice Location | |||||||||
| Address1: | 3810 WULFF RD E | ||||||||
| Address2: | |||||||||
| City: | SEMMES | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365755256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514450582 | ||||||||
| FaxNumber: | 2514450584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 06/02/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 00026552 | AL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 26552 | AL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 51535966 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 51535967 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 303799379 | 05 | AL | MEDICAID | 303749379 | 05 | AL | MEDICAID | 303729379 | 05 | AL | MEDICAID | 303769379 | 05 | AL | MEDICAID | 51535968 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 303709379 | 05 | AL | MEDICAID | 303719379 | 05 | AL | MEDICAID | 303739379 | 05 | AL | MEDICAID | 011846 | 01 | AL | MEDICARE GROUP NUMBER | OTHER | 1063439065 | 01 | AL | NPI GROUP PAYEE NUMBER | OTHER |