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Contact Information

IMC-PEDIATRIC & ADOLESCENT MEDICINE, LLC
4013 AIRPORT BLVD STE C
MOBILE, AL36608-2201
 Phone: 251-435-5437
 Fax: 251-435-6744
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Adolescent Medicine

2080A0000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for IMC-PEDIATRIC & ADOLESCENT MEDICINE, LLC

NPI # 1205905361
LBN Legal business name IMC-PEDIATRIC & ADOLESCENT MEDICINE, LLC
Authorized official ANTHONY PALAZZO - (VICE PRESIDENT OF FINANCE)
Entity Organization
Organization subpart 1 No
Enumeration date 11/06/2006
Last updated 06/26/2020 - About 6 years ago
Identifiers
AL Medicaid 529801010
AL Other 51032409 AL BCBS
AL Other 51032411 AL BCBS
AL Other 51032412 AL BCBS
AL Other 51032413 AL BCBS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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