Basic Information
| Provider Information | |||||||||
| NPI: | 1679009286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHLAND HOSPITALIST AT OPP, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 PARKWOOD PL | ||||||||
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| City: | NICEVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325788700 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 702 N MAIN ST | ||||||||
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| City: | OPP | ||||||||
| State: | AL | ||||||||
| PostalCode: | 364671626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3344933541 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2017 | ||||||||
| LastUpdateDate: | 05/03/2017 | ||||||||
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| AuthorizedOfficialLastName: | BELL | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3523758009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.