Provider Demographics
NPI:1639391162
Name:GADSDEN PULMONARY & SLEEP CLINIC, PC
Entity Type:Organization
Organization Name:GADSDEN PULMONARY & SLEEP CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM. ASST.
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:AUTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-547-4443
Mailing Address - Street 1:311 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5212
Mailing Address - Country:US
Mailing Address - Phone:256-547-4443
Mailing Address - Fax:256-547-4476
Practice Address - Street 1:311 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5212
Practice Address - Country:US
Practice Address - Phone:256-547-4443
Practice Address - Fax:256-547-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00017313207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1639391162OtherORGANIZATIONAL (GROUP) NATIONAL PROVIDER IDENTIFIER
AL510-85402OtherBCBS PROVIDER NUMBER
AL1609855063OtherINDIVIDUAL NPI
AL009925660Medicaid
AL529904380Medicaid
AL000085402Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
AL529904380Medicaid
ALF62578Medicare UPIN