Organization
FORT PAYNE PEDIATRICS LLC
Active
Other names
Ft Payne Pediatrics,LLC
Organization subpart
No
Provider details
NPI number
Authorized official
PETER STROGOV MD (PHYSICIAN/OWNER)
(256) 997-5900
Entity
Organization
Contact information
Practice address
1906 GLENN BLVD SW STE 100A, FORT PAYNE, AL 35968-3546
(256) 997-5900
Mailing address
1906 GLENN BLVD SW STE 100A, FORT PAYNE, AL 35968-3546
(256) 997-5900
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
30426
AL
261QR1300X
Rural Health Clinic/Center
Primary
01-8910
AL
363LF0000X
Family Nurse Practitioner
1-075895
AL
363LF0000X
Family Nurse Practitioner
1-087445
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139385
—
AL
Enumeration date
04/24/2012
Last updated
03/31/2014
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