MEDICARE: DR. AMY JARVIS ALBERT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	00024809	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	515-21358	OTHER	AL	BC/BS PROVIDER

General Provider Information

NPI Number	:	1952303711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY JARVIS ALBERT M.D.

Provider Business Mailing Address
First Line	:	5330 STADIUM TRACE PKWY
Second Line	:	STE. 150
City	:	HOOVER
State	:	AL
Zip	:	35244-4538
Country	:	US
Telephone Number	:	205-985-9424
Fax Number	:	205-985-9465

Provider Business Practice Location Address
First Line	:	5330 STADIUM TRACE PKWY
Second Line	:	STE. 150
City	:	HOOVER
State	:	AL
Zip	:	35244-4538
Country	:	US
Telephone Number	:	205-985-9424
Fax Number	:	205-985-9465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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