Provider Demographics
NPI:1790971166
Name:PUROHIT PEDIATRIC CLINIC, LLC
Entity Type:Organization
Organization Name:PUROHIT PEDIATRIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:NARESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PUROHIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-741-9799
Mailing Address - Street 1:516 QUINTARD AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-5754
Mailing Address - Country:US
Mailing Address - Phone:256-741-9799
Mailing Address - Fax:256-741-9795
Practice Address - Street 1:516 QUINTARD AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-5754
Practice Address - Country:US
Practice Address - Phone:256-741-9799
Practice Address - Fax:256-741-9795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00015626174400000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL559914700Medicaid