Provider Demographics
NPI:1013771179
Name:ROCKET CITY PEDIATRICS
Entity Type:Organization
Organization Name:ROCKET CITY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-635-8627
Mailing Address - Street 1:303 WILLIAMS AVE SW STE 1211
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6082
Mailing Address - Country:US
Mailing Address - Phone:256-635-8627
Mailing Address - Fax:
Practice Address - Street 1:303 WILLIAMS AVE SW STE 1211
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6082
Practice Address - Country:US
Practice Address - Phone:256-635-8627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty