=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477522175
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANCI M BALAS HOESLEY MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2006
-----------------------------------------------------
Last Update Date | 06/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3735 CORPORATE WOODS DR STE 105
-----------------------------------------------------
City | VESTAVIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35242-2296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-900-7337
-----------------------------------------------------
Fax | 855-583-3156
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3735 CORPORATE WOODS DR STE 105
-----------------------------------------------------
City | VESTAVIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35242-2296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-900-7337
-----------------------------------------------------
Fax | 855-583-3156
-----------------------------------------------------
=====================================================
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 | 00017481
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------