Organization
EASTSIDE VENTURES, INC.
Active
Other names
Oneonta Internal Medicine and Peds
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICKI H PARKS CPA (CHIEF ACCOUNTING OFFICER)
(205) 838-3718
Entity
Organization
Contact information
Practice address
150 GILBREATH DR, SUITE 201, ONEONTA, AL 35121-2827
(205) 625-5711
Mailing address
150 GILBREATH DR, SUITE 201, ONEONTA, AL 35121-2827
(205) 625-5711
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529703050
—
AL
01
—
E893
MEDICARE PT B
—
Enumeration date
03/15/2007
Last updated
02/03/2011
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