Provider Demographics
NPI:1972985968
Name:ATHENS LIMESTONE PEDIATRIC CENTER LLC
Entity type:Organization
Organization Name:ATHENS LIMESTONE PEDIATRIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEBRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-216-9648
Mailing Address - Street 1:700 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2457
Mailing Address - Country:US
Mailing Address - Phone:256-216-9730
Mailing Address - Fax:256-216-9731
Practice Address - Street 1:101 FITNESS WAY STE 2100
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2494
Practice Address - Country:US
Practice Address - Phone:256-216-9730
Practice Address - Fax:256-216-9731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health