Provider Demographics
NPI:1750977583
Name:PRISTINE HEALTHCARE PC
Entity type:Organization
Organization Name:PRISTINE HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /MD
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-929-3528
Mailing Address - Street 1:400 WHITESPORT DR SW STE 104
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6429
Mailing Address - Country:US
Mailing Address - Phone:256-929-3528
Mailing Address - Fax:888-502-7316
Practice Address - Street 1:400 WHITESPORT DR SW STE 104
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6429
Practice Address - Country:US
Practice Address - Phone:256-929-3528
Practice Address - Fax:888-502-7316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty