=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326071366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RHONDA R BEDSOLE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 06/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3810 WULFF RD E
-----------------------------------------------------
City | SEMMES
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36575-5256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-445-0582
-----------------------------------------------------
Fax | 251-445-0584
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2867
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36652-2867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-690-8894
-----------------------------------------------------
Fax | 251-544-2188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 00026552
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 26552
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------