Healthcare Provider Details

I. General information

NPI: 1689088650
Provider Name (Legal Business Name): NEONATOLOGY ASSOCIATES OF TUSCALOOSA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 UNIVERSITY BLVD E
TUSCALOOSA AL
35401-2029
US

IV. Provider business mailing address

10250 LAKE SIDE DR
TUSCALOOSA AL
35406-5007
US

V. Phone/Fax

Practice location:
  • Phone: 205-333-4655
  • Fax: 205-333-4660
Mailing address:
  • Phone: 205-333-4655
  • Fax: 205-333-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAVIER REPETTO
Title or Position: ACTING MANAGER/SECRETARY
Credential: M.D.
Phone: 205-333-4655