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General NPI Number Information
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NPI Number | 1336634666
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Entity Type | Organization
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Legal Business Name | CENTRAL PEDIATRICS OF SOMERVILLE LLC
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 3609 HIGHWAY 67 S
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City | SOMERVILLE
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State | AL
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Zip | 35670
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Country | US
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Telephone | 256-233-0712
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Fax |
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Provider Business Mailing Address
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Address Line | 101 FITNESS WAY STE 1100
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City | ATHENS
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State | AL
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Zip | 35611-2481
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Country | US
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Telephone | 256-233-0712
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Fax |
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Authorized Official
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Title or Position | CFO OFFICE MGR
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Name | CHRISTY THOMAS RUTHERFORD
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Credential |
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Telephone | 256-233-0712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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