Provider Demographics
NPI:1134296817
Name:THE WOMEN'S PAVILION, PC
Entity Type:Organization
Organization Name:THE WOMEN'S PAVILION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-234-3477
Mailing Address - Street 1:59 ALISON DR STE 8
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-4411
Mailing Address - Country:US
Mailing Address - Phone:256-234-3477
Mailing Address - Fax:
Practice Address - Street 1:59 ALISON DR STE 8
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-4411
Practice Address - Country:US
Practice Address - Phone:256-234-3477
Practice Address - Fax:256-234-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529403570Medicaid
ALD421Medicare ID - Type Unspecified