Provider Demographics
NPI:1336361732
Name:TUSCALOOSA NEWBORN MEDICINE PC
Entity Type:Organization
Organization Name:TUSCALOOSA NEWBORN MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:GODOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-333-4661
Mailing Address - Street 1:1820 RICE MINE RD NORTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-3282
Mailing Address - Country:US
Mailing Address - Phone:205-333-4661
Mailing Address - Fax:205-333-4660
Practice Address - Street 1:1820 RICE MINE RD NORTH
Practice Address - Street 2:SUITE 200
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-3282
Practice Address - Country:US
Practice Address - Phone:205-333-4661
Practice Address - Fax:205-333-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL112312080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51080276OtherBLUE CROSS NUMBER