Provider Demographics
NPI:1790844884
Name:INFECTIOUS DISEASE CONSULTANTS
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-533-4640
Mailing Address - Street 1:101 BOB WALLACE AVE SW STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3843
Mailing Address - Country:US
Mailing Address - Phone:256-533-4640
Mailing Address - Fax:256-533-4647
Practice Address - Street 1:101 BOB WALLACE AVE SW STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3843
Practice Address - Country:US
Practice Address - Phone:256-533-4640
Practice Address - Fax:256-533-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8559174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI15633Medicare UPIN
ALC78851Medicare UPIN