Healthcare Provider Details

I. General information

NPI: 1144284084
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF ALEXANDER CITY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1962 CHEROKEE RD
ALEXANDER CITY AL
35010-3437
US

IV. Provider business mailing address

PO BOX 1269
ALEXANDER CITY AL
35011-1269
US

V. Phone/Fax

Practice location:
  • Phone: 256-234-5021
  • Fax: 256-234-5640
Mailing address:
  • Phone: 256-234-5021
  • Fax: 256-234-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC OWEN TYLER
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 256-234-5021