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General NPI Number Information
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NPI Number | 1649855545
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Entity Type | Organization
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Legal Business Name | EASTSIDE P.E.T. CENTER, LLC
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Dates
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Enumeration Date | 03/11/2021
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 7191 CAHABA VALLEY RD BLDG 2 STE 203
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City | HOOVER
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State | AL
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Zip | 35242-6448
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Country | US
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Telephone | 205-236-9943
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Fax | 205-236-9947
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Provider Business Mailing Address
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Address Line | 406 MEDICAL CENTER DR
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City | JASPER
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State | AL
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Zip | 35501-3400
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Country | US
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Telephone | 205-221-8200
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Fax | 205-221-8270
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | LISA J. WELLS
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Credential | CPCO
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Telephone | 205-221-8258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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