Healthcare Provider Details

I. General information

NPI: 1548757420
Provider Name (Legal Business Name): DPI OF ALABAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 KELLY CREEK RD
MOODY AL
35004
US

IV. Provider business mailing address

PO BOX 14447
BATON ROUGE LA
70898-4447
US

V. Phone/Fax

Practice location:
  • Phone: 225-923-0030
  • Fax: 225-923-0060
Mailing address:
  • Phone: 225-923-0030
  • Fax: 225-923-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JOHN SIKES
Title or Position: CEO
Credential:
Phone: 225-923-0030