Provider Demographics
NPI:1063511582
Name:ADOLESCENT & PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:ADOLESCENT & PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-288-0009
Mailing Address - Street 1:2611 WOODLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-3834
Mailing Address - Country:US
Mailing Address - Phone:334-288-0009
Mailing Address - Fax:334-281-7453
Practice Address - Street 1:2611 WOODLEY PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-3834
Practice Address - Country:US
Practice Address - Phone:334-288-0009
Practice Address - Fax:334-281-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C76709Medicare UPIN
ALC70412Medicare UPIN
81986Medicare ID - Type UnspecifiedTHEODORE R SMITH MD
AL9675Medicare ID - Type UnspecifiedALBERT Z HOLLOWAY MD