Provider Demographics
NPI:1316005481
Name:CRITICAL CARE PEDIATRICS
Entity type:Organization
Organization Name:CRITICAL CARE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONJA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-656-5789
Mailing Address - Street 1:PO BOX 2856
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2856
Mailing Address - Country:US
Mailing Address - Phone:256-656-5789
Mailing Address - Fax:
Practice Address - Street 1:911 BIG COVE RD SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3750
Practice Address - Country:US
Practice Address - Phone:256-265-7946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22150207L00000X, 2080P0203X
AL206932080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Not Answered2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51093653OtherBCBS
AL51092779OtherBCBS