Provider Demographics
NPI:1134814155
Name:TADPOLE PEDIATRICS, LLC
Entity type:Organization
Organization Name:TADPOLE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-234-4443
Mailing Address - Street 1:PO BOX 2008
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35011-2008
Mailing Address - Country:US
Mailing Address - Phone:256-234-4443
Mailing Address - Fax:256-234-3686
Practice Address - Street 1:44 ALIANT PKWY
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3466
Practice Address - Country:US
Practice Address - Phone:256-234-4443
Practice Address - Fax:256-234-3686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty