Provider Demographics
NPI:1104137439
Name:PEDIATRICS PLUS, P.C.
Entity type:Organization
Organization Name:PEDIATRICS PLUS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-241-2671
Mailing Address - Street 1:3312 HENRY RD
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-6344
Mailing Address - Country:US
Mailing Address - Phone:256-241-2671
Mailing Address - Fax:256-241-2676
Practice Address - Street 1:3312 HENRY RD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-6344
Practice Address - Country:US
Practice Address - Phone:256-241-2671
Practice Address - Fax:256-241-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14173208000000X
AL1084368363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL122015Medicaid