Healthcare Provider Details

I. General information

NPI: 1134814155
Provider Name (Legal Business Name): TADPOLE PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 ALIANT PKWY
ALEXANDER CITY AL
35010-3466
US

IV. Provider business mailing address

PO BOX 2008
ALEXANDER CITY AL
35011-2008
US

V. Phone/Fax

Practice location:
  • Phone: 256-234-4443
  • Fax: 256-234-3686
Mailing address:
  • Phone: 256-234-4443
  • Fax: 256-234-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARIE HANNA
Title or Position: OWNER
Credential: CRNP
Phone: 256-234-4443