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General NPI Number Information
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NPI Number | 1396884524
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Entity Type | Organization
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Legal Business Name | PEDIATRIC INTENSIVIST
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 401 LOWELL DR SE SUITE 14
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3748
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Country | US
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Telephone | 256-265-7791
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Fax | 256-265-7767
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Provider Business Mailing Address
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Address Line | 401 LOWELL DR SE SUITE 14
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3748
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Country | US
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Telephone | 256-265-7791
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Fax | 256-265-7767
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Authorized Official
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Title or Position | DIRECTOR OF PHYSICIANS NETWORK
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Name | HEATHER MASON
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Credential |
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Telephone | 256-265-7791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number |
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License Number State |
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