Basic Information
| Provider Information | |||||||||
| NPI: | 1598881617 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUNTSVILLE HOSPITAL PEDIATRIC NEUROLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21007 | ||||||||
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| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358135007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568016036 | ||||||||
| FaxNumber: | 2568016218 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 LOWELL DR SE | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358013748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562651775 | ||||||||
| FaxNumber: | 2562651780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| AuthorizedOfficialLastName: | CARTER | ||||||||
| AuthorizedOfficialFirstName: | CLINTON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2562658818 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0402X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
No ID Information.