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General NPI Number Information
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NPI Number | 1437705704
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Entity Type | Organization
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Legal Business Name | IMC EASTERN SHORE WOMEN'S HEALTH LLC
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 188 HOSPITAL DR STE 202
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City | FAIRHOPE
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State | AL
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Zip | 36532-2038
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Country | US
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Telephone | 251-279-3794
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Fax |
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Provider Business Mailing Address
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Address Line | 188 HOSPITAL DR STE 202
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City | FAIRHOPE
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State | AL
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Zip | 36532-2038
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Country | US
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Telephone | 251-279-3794
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF FINANCE
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Name | ANTHONY PALAZZO
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Credential |
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Telephone | 251-435-1361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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