Provider Demographics
NPI:1316714512
Name:ABC PEDIATRICS WEST LLC
Entity type:Organization
Organization Name:ABC PEDIATRICS WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED RN PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:VARDEN
Authorized Official - Last Name:GANN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:205-936-8107
Mailing Address - Street 1:400 19TH ST E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-5416
Mailing Address - Country:US
Mailing Address - Phone:205-936-8107
Mailing Address - Fax:205-512-2548
Practice Address - Street 1:400 19TH ST E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-5416
Practice Address - Country:US
Practice Address - Phone:205-936-8107
Practice Address - Fax:205-512-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty