Carole Boudreaux, MD
Individual provider Active NPI Anatomic Pathology & Clinical Pathology Physician · Mobile, AL
NPI 1083664239 · NPPES record last updated Dec 3, 2015
Key facts
- NPI
- 1083664239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- License
- 16509 (AL)
- Practice address
- 2451 Fillingim St
Pathology
Mobile, AL 36617-2238 - Phone
- (251) 471-7790
- Fax
- (251) 471-7715
- NPI assigned
- May 10, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16509 | AL | MD | Cytopathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mobile Infirmary Association | Current | Accepting new patients | |
| Mobile Infirmary Association | Current | Accepting new patients | |
| USA Health - Mci Business Services LLC | Anatomic Pathology & Clinical Pathology | Current | Accepting new patients |
| USA Health Physician Billing Services LLC | Current | Accepting new patients |
Locations
1660 Spring Hill Ave
Mobile, AL 36604
Phone (251) 445-9616
1660 Spring Hill Ave
Ste 3069
Mobile, AL 36604
Phone (251) 445-8405
5 Mobile Infirmary Cir
Mobile, AL 36607
Phone (251) 432-4415
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cytopathology Physician | 207ZC0500X | 16509 | AL | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 16509 | AL | Yes |
Addresses
Primary practice location
2451 Fillingim St
Pathology
Mobile, AL 36617-2238
Mailing address
PO Box 40480
Mobile, AL 36640-0480
Phone (251) 471-7790
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00118221 | Medicaid | MS | |
| 1523593 | Medicaid | LA | |
| 51024061 | Other | AL | BCBS |
| 11-10270 | Other | AL | UNITED HEALTHCARE |
| 000024061 | Medicaid | AL | |
| 255587500 | Medicaid | FL |
Other providers in Mobile, AL
- Jon Botts
- Helen Elizabeth Boucher
- Michael J Boucher
- Susan Marisa Boucher
- Floyd T Boudreau
- Evangeline Simone Boudreaux
- Michael C Boudreaux
- Randall C Boudreaux
- Sheila Bouler
- Jane G Boulo
All providers in Mobile, AL · Anatomic Pathology & Clinical Pathology Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.