=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174880660
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALC CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2012
-----------------------------------------------------
Last Update Date | 04/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4900 BAYOU BLVD SUITE 107
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503-2525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-607-6269
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4900 BAYOU BLVD SUITE 107
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503-2525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-607-6269
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. ALICIA L CHEN
-----------------------------------------------------
Credential | M.D.,
-----------------------------------------------------
Telephone | 850-607-6269
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME80686
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------