MEDICARE: PEPPERELL PRIMARY CARE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD.12134	AL

General Provider Information

NPI Number	:	1518219716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEPPERELL PRIMARY CARE, PC

Provider Business Mailing Address
First Line	:	1245 E SOUTH BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2315
Country	:	US
Telephone Number	:	334-281-3030
Fax Number	:	334-281-4566

Provider Business Practice Location Address
First Line	:	1245 E SOUTH BLVD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2315
Country	:	US
Telephone Number	:	334-281-3030
Fax Number	:	334-281-4566

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID J KNAPP
Credential	:	M.D.
Telephone Number	:	334-233-2417

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	05/22/2015

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