Provider Demographics
NPI:1619095601
Name:PEDIATRIC ASSOCIATES OF MOBILE, PA
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF MOBILE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-344-1502
Mailing Address - Street 1:3719 DAUPHIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1753
Mailing Address - Country:US
Mailing Address - Phone:251-344-1502
Mailing Address - Fax:251-342-1116
Practice Address - Street 1:3719 DAUPHIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1753
Practice Address - Country:US
Practice Address - Phone:251-344-1502
Practice Address - Fax:251-342-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty