Basic Information
| Provider Information | |||||||||
| NPI: | 1407508872 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOCUS-MD AL 1019 LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 88061 | ||||||||
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| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366080061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513788635 | ||||||||
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| Practice Location | |||||||||
| Address1: | 802 SHONEY DR SW | ||||||||
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| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358015404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2569373500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2022 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | COLLINS | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2516101618 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.