Provider Demographics
NPI:1881182236
Name:INTERFACE MEDICAL CONSULTING LLC
Entity Type:Organization
Organization Name:INTERFACE MEDICAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALISTS
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:INGENITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-352-3063
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-0146
Mailing Address - Country:US
Mailing Address - Phone:251-689-7168
Mailing Address - Fax:
Practice Address - Street 1:12141 CRI
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-689-7168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty