Healthcare Provider Details

I. General information

NPI: 1538271150
Provider Name (Legal Business Name): ICE HEALTHCARE SERVICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1758 SPRING HILL AVE
MOBILE AL
36607-3508
US

IV. Provider business mailing address

PO BOX 9158
MOBILE AL
36691-0158
US

V. Phone/Fax

Practice location:
  • Phone: 251-460-0326
  • Fax:
Mailing address:
  • Phone: 251-460-0326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY ILIFF
Title or Position: MD
Credential:
Phone: 251-460-0326