Provider Demographics
NPI:1083078596
Name:PRIMARY CARE PEDIATRICS AND FAMILY MEDICINE, P.C
Entity Type:Organization
Organization Name:PRIMARY CARE PEDIATRICS AND FAMILY MEDICINE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHRADDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRESTHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-425-3668
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:CAPSHAW
Mailing Address - State:AL
Mailing Address - Zip Code:35742-0269
Mailing Address - Country:US
Mailing Address - Phone:256-262-1040
Mailing Address - Fax:256-325-2180
Practice Address - Street 1:29869 CAPSHAW ROAD
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749
Practice Address - Country:US
Practice Address - Phone:256-262-1040
Practice Address - Fax:256-325-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty