Provider Demographics
NPI:1194208389
Name:PATHWAY HEALTHCARE ALABAMA LLC
Entity type:Organization
Organization Name:PATHWAY HEALTHCARE ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCEARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-891-0708
Mailing Address - Street 1:580 PROVIDENCE PARK DR E STE 125
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:580 PROVIDENCE PARK DR E STE 125
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4614
Practice Address - Country:US
Practice Address - Phone:251-219-9810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAY HEALTHCARE ALABAMA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty