Provider Demographics
NPI:1609933514
Name:LADIGA MEDICAL, LLC
Entity Type:Organization
Organization Name:LADIGA MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-435-2180
Mailing Address - Street 1:1460 A SECOND AVE SW
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265
Mailing Address - Country:US
Mailing Address - Phone:256-435-2180
Mailing Address - Fax:256-435-9525
Practice Address - Street 1:1460 2ND AVE SW # A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3358
Practice Address - Country:US
Practice Address - Phone:256-435-2180
Practice Address - Fax:256-435-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7858173000000X
AL9644173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC74381Medicare UPIN
ALC72397Medicare UPIN
AL51519575Medicare PIN
AL51519662Medicare PIN