Provider Demographics
NPI:1063679496
Name:PARTNERS IN PEDIATRICS LLC
Entity Type:Organization
Organization Name:PARTNERS IN PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/ACTING OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAMENDA
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:BLAKENEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-272-1799
Mailing Address - Street 1:8160 SEATON PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-7204
Mailing Address - Country:US
Mailing Address - Phone:334-272-1799
Mailing Address - Fax:334-272-4876
Practice Address - Street 1:136 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-3114
Practice Address - Country:US
Practice Address - Phone:334-272-1799
Practice Address - Fax:334-272-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22059261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care