Provider Demographics
NPI:1114925906
Name:HUNTSVILLE OB/GYN, ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:HUNTSVILLE OB/GYN, ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPING
Authorized Official - Prefix:MRS
Authorized Official - First Name:NENA
Authorized Official - Middle Name:F
Authorized Official - Last Name:DICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-881-4357
Mailing Address - Street 1:165 WHITESPORT DR SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-7426
Mailing Address - Country:US
Mailing Address - Phone:256-881-4357
Mailing Address - Fax:256-881-4389
Practice Address - Street 1:165 WHITESPORT DR SW
Practice Address - Street 2:SUITE 1
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7426
Practice Address - Country:US
Practice Address - Phone:256-881-4357
Practice Address - Fax:256-881-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO123174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC78942Medicare UPIN
ALC75064Medicare UPIN