Healthcare Provider Details

I. General information

NPI: 1720448897
Provider Name (Legal Business Name): RIVERSIDE PEDIATRICS OF DECATUR LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 13TH AVE SE STE D
DECATUR AL
35601-4316
US

IV. Provider business mailing address

1304 13TH AVE SE STE D
DECATUR AL
35601-4316
US

V. Phone/Fax

Practice location:
  • Phone: 256-355-1843
  • Fax: 256-340-2553
Mailing address:
  • Phone: 256-355-1843
  • Fax: 256-340-2553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DAVID V PARMER
Title or Position: OWNER/PARTNER
Credential: M.D.
Phone: 256-355-1843