Provider Demographics
NPI:1558326611
Name:MICHAEL W. PEADEN MD PC
Entity Type:Organization
Organization Name:MICHAEL W. PEADEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BELLEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-283-3477
Mailing Address - Street 1:115 HERREN HILL RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1276
Mailing Address - Country:US
Mailing Address - Phone:334-283-3477
Mailing Address - Fax:
Practice Address - Street 1:115 HERREN HILL RD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1276
Practice Address - Country:US
Practice Address - Phone:334-283-3477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529916890Medicaid
AL051516972Medicare PIN
ALE47004Medicare UPIN