Healthcare Provider Details

I. General information

NPI: 1437705704
Provider Name (Legal Business Name): IMC EASTERN SHORE WOMEN'S HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 HOSPITAL DR STE 202
FAIRHOPE AL
36532-2038
US

IV. Provider business mailing address

188 HOSPITAL DR STE 202
FAIRHOPE AL
36532-2038
US

V. Phone/Fax

Practice location:
  • Phone: 251-279-3794
  • Fax:
Mailing address:
  • Phone: 251-279-3794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY PALAZZO
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 251-435-1361