Provider Demographics
NPI:1265681167
Name:MENDIOLA PC
Entity Type:Organization
Organization Name:MENDIOLA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMELO
Authorized Official - Middle Name:C
Authorized Official - Last Name:MENDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-997-2820
Mailing Address - Street 1:2202 JORDAN RD SW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968
Mailing Address - Country:US
Mailing Address - Phone:256-997-2820
Mailing Address - Fax:256-997-2890
Practice Address - Street 1:1003 FAIRWAY RD NW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-8226
Practice Address - Country:US
Practice Address - Phone:256-996-3239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty