Basic Information
| Provider Information | |||||||||
| NPI: | 1558762393 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMMH SCOTTSBORO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4535 DRESSLER RD NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447182545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304934443 | ||||||||
| FaxNumber: | 3304928489 | ||||||||
| Practice Location | |||||||||
| Address1: | 380 WOODS COVE RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSBORO | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357682428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068623002 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2014 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | CHARLEY | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF LEGAL OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 2406862300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | ESQ | ||||||||
| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.