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Organization
IMC-PEDIATRIC & ADOLESCENT MEDICINE, LLC
Active
Organization
IMC-PEDIATRIC & ADOLESCENT MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY PALAZZO (VICE PRESIDENT OF FINANCE)
(251) 435-1361
Entity
Organization
Contact information
Practice address
4013 AIRPORT BLVD STE C, MOBILE, AL 36608-2201
(251) 435-5437
(251) 435-6744
Mailing address
4013 AIRPORT BLVD STE C, MOBILE, AL 36608-2201
(251) 435-5437
(251) 435-6744
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51032409
AL BCBS
AL
01
—
51032411
AL BCBS
AL
01
—
51032412
AL BCBS
AL
01
—
51032413
AL BCBS
AL
05
—
529801010
—
AL
Enumeration date
11/06/2006
Last updated
06/26/2020
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