Healthcare Provider Details

I. General information

NPI: 1679665848
Provider Name (Legal Business Name): NORTH RIVER E.N.T., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 MCFARLAND BLVD NE SUITE A
TUSCALOOSA AL
35406
US

IV. Provider business mailing address

1224 MCFARLAND BLVD NE SUITE A
TUSCALOOSA AL
35406
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-9930
  • Fax: 205-759-9931
Mailing address:
  • Phone: 205-759-9930
  • Fax: 205-759-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. RENE SULLIVAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 205-759-9930