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General NPI Number Information
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NPI Number | 1851454946
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Entity Type | Organization
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Legal Business Name | NORTHSIDE,P.C.
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 1020 CLEVELAND RD
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City | SARALAND
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State | AL
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Zip | 36571
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Country | US
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Telephone | 251-675-4733
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Fax | 251-679-9874
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Provider Business Mailing Address
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Address Line | 1020 CLEVELAND RD
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City | SARALAND
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State | AL
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Zip | 36571
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Country | US
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Telephone | 251-675-4733
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Fax | 251-679-9874
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEBBIE KRUSE
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Credential |
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Telephone | 251-675-4733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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