IMC-PEDIATRIC & ADOLESCENT MEDICINE, LLC (NPI# 1205905361) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205905361 |
| Entity Type | Organization |
| Organization Name | IMC-PEDIATRIC & ADOLESCENT MEDICINE, LLC |
| Practice Address |
4013 Airport Blvd Ste C Mobile AL 36608-2201 |
| Practice Telephone | 2514355437 |
| Practice Fax Number | 2514356744 |
| Mailing Telephone | 2514355437 |
| Mailing Fax Number | 2514356744 |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2020-06-26 |
| Authorized Official Name | ANTHONY PALAZZO (VICE PRESIDENT OF FINANCE) |
| Authorized Official Telephone | 2514351361 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
AL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | AL BCBS | 51032409 | 01 |
| AL | AL BCBS | 51032412 | 01 |
| AL | AL BCBS | 51032411 | 01 |
| AL | AL BCBS | 51032413 | 01 |
| AL | 529801010 | 05 |
| Street Address |
4013 AIRPORT BLVD STE C |
| City | MOBILE |
| State | AL |
| Zip Code | 36608-2201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475524 | Grantham Dental, Inc. | Dentist | 3620 Springhill Memorial Drive South, Mobile, AL 36608 | 2020-10-21 |
| 1114540879 | Dearrius Hines | Home Health Aide | 1370 Lucerne Dr, Mobile, AL 36608 | 2020-05-28 |
| 1558980409 | Rachel Stevens | Registered Nurse | 8507 Tanner Williams Rd, Mobile, AL 36608 | 2020-04-10 |
| 1073170700 | Usa Health Physician Billing Services LLC | Otolaryngology | 5721 Usa Drive North, Hahn 1119, Mobile, AL 36608 | 2019-05-29 |
| 1952885600 | Franklin Primary Health Center Inc. | Dentist | 990 Cody Rd North, Mobile, AL 36608 | 2018-09-19 |
| 1114410040 | Zackary Elkins | Optometrist | 105 W I65 Service Rd N, Mobile, AL 36608 | 2018-06-14 |
| 1023562865 | Covenant Hospice, Inc. | Internal Medicine | 6801 Airport Blvd., Main Tower, 11th Floor North, Mobile, AL 36608 | 2016-08-10 |
| 1730575416 | Rayven Likely | Student in an Organized Health Care Education/Training Program | 1014 Centerwood Dr, Mobile, AL 36608 | 2015-04-09 |
| 1598040461 | Robert S Harlin | Specialist | 75 Clarise Circle, Mobile, AL 36608 | 2011-10-11 |
| 1972884948 | Heidi Michelle Mcdermott | Physical Therapist | 5721 Usa Drive N, Hahn 2050, Mobile, AL 36608 | 2011-09-06 |
| Find all providers in zip 36608 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285960674 | Just Kidz Medical LLC | Pediatrics | 5466 Old Shell Rd, Ste. A, Mobile, AL 36608-3046 | 2009-10-20 |
| 1629028642 | Carmel Health Network | Pediatrics | 1653 Springhill Ave, Mobile, AL 36604-1404 | 2006-05-11 |
| 1396776050 | Joseph L Stadther | Pediatrics | 820 University Blvd S, Suite 1 B, Mobile, AL 36609-7858 | 2006-07-05 |
| 1124056957 | Debra Gardner | Pediatrics | 3290 Dauphin St, Suite 301, Mobile, AL 36606-4062 | 2006-06-29 |
| 1316975279 | Mary S Wells | Pediatrics | 3290 Dauphin St, Suite 301, Mobile, AL 36606-4062 | 2006-06-29 |
| 1487682258 | James B Harrell | Pediatrics | 3290 Dauphin St, Suite 301, Mobile, AL 36606-4062 | 2006-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154810224 | Kids Clinic Pediatric and Adolescent Medicine | Pediatrics | 101 Stephen J White Memorial Blvd, Talladega, AL 35160-2106 | 2018-05-04 |
| 1023452406 | Samantha Veronica Hill | Pediatrics | The University of Alabama At Birmingham, 1600 5th Ave South, Birmingham, AL 35233 | 2013-04-29 |
| 1508011297 | Marshall Medical Center South Pediatric Hospital Services | Pediatrics | 227 Brittany Rd, Guntersville, AL 35976-5766 | 2008-11-21 |
| 1427252766 | Medpeds of Dothan Inc | Pediatrics | 318 Westgate Pkwy Ste 2, Dothan, AL 36303-2963 | 2007-06-12 |
| 1295871556 | Evelyn Simpkins Evans | Pediatrics | Health Services, Inc, 1845 Cherry Street, Montgomery, AL 36107-0365 | 2007-01-30 |
| 1033276035 | Brenda Layton Mcgivern | Pediatrics | 300 W Pettus St, Demopolis, AL 36732-2830 | 2007-01-02 |
| 1063511582 | Adolescent & Pediatric Associates | Pediatrics | 2611 Woodley Park Dr, Montgomery, AL 36116-3834 | 2006-09-21 |
| 1588683262 | Milton Stanhope Brasfield IIi | Pediatrics | 105 Hwy 80 East, Suite 205, Demopolis, AL 36732 | 2006-07-19 |
| 1659329191 | James Wesley Rabon | Pediatrics | 420 Cotton Gin Rd, Montgomery, AL 36117-3557 | 2006-05-05 |
| 1821077413 | Richard Mcconnell Freeman | Pediatrics | 2901 Corporate Park Dr, Opelika, AL 36801-7283 | 2006-01-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.