Provider Demographics
NPI:1568466597
Name:JANE PEARSON MD PA
Entity Type:Organization
Organization Name:JANE PEARSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-939-0196
Mailing Address - Street 1:2660 10TH AVE S
Mailing Address - Street 2:STE 520
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1605
Mailing Address - Country:US
Mailing Address - Phone:205-939-0196
Mailing Address - Fax:
Practice Address - Street 1:2660 10TH AVE S
Practice Address - Street 2:STE 520
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1605
Practice Address - Country:US
Practice Address - Phone:205-939-0196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2009-04-22
Deactivation Date:2007-08-03
Deactivation Code:
Reactivation Date:2007-08-31
Provider Licenses
StateLicense IDTaxonomies
AL41812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL44910OtherBLUE CROSS
P12 023034OtherMULTIPLAN HEALTH EOS
07 49400OtherUMWA HEALTH AND RETIREMEN
AL408013720OtherRAILROAD MEDICARE
AL4282422OtherAETNA
AL000044910Medicaid
0510008OtherUNITED HEALTHCARE
AL000044910Medicaid
ALL245Medicare PIN
AL000044910Medicare PIN