Healthcare Provider Details

I. General information

NPI: 1033135231
Provider Name (Legal Business Name): HEALTH SUPPORT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 HIGHWAY 90 SUITE 204
DAPHNE AL
36526
US

IV. Provider business mailing address

7101 HIGHWAY 90 SUITE 204
DAPHNE AL
36526
US

V. Phone/Fax

Practice location:
  • Phone: 251-625-8260
  • Fax: 251-625-8264
Mailing address:
  • Phone: 251-625-8260
  • Fax: 251-625-8264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RAYMOND D A PETERSON
Title or Position: OWNER PHYSICIAN
Credential: MD
Phone: 251-625-8260