Active NPI
Stacey W. Wing, MD
- Internal Medicine Physician
- Mobile, AL
National Provider Identifier
1093761702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 21251
- Practice address
- 610 Providence Park Dr E
BLDG 1 - Suite 102
Mobile, AL 36695-4622 - Phone
- (251) 378-3900
- Fax
- (251) 378-3901
- NPI assigned
- May 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 21251 | AL | Primary |
Addresses
Primary practice location
610 Providence Park Dr E
BLDG 1 - Suite 102
Mobile, AL 36695-4622
Mailing address
PO Box 850489
Mobile, AL 36685-0489
Phone (251) 342-3949
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 117354 | Medicaid | AL | |
| 511-01630 | Other | AL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21251 | AL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of South Alabama Health Services Foundation | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Medical Laboratory
- Mobile, AL
- NPI 1548357916
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296691200000",
"number": "1093761702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 850489",
"city": "MOBILE",
"state": "AL",
"postal_code": "366850489",
"telephone_number": "251-342-3949",
"fax_number": "251-631-3361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 PROVIDENCE PARK DR E",
"address_2": "BLDG 1 - SUITE 102",
"city": "MOBILE",
"state": "AL",
"postal_code": "366954622",
"telephone_number": "251-378-3900",
"fax_number": "251-378-3901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WING",
"first_name": "STACEY",
"middle_name": "W.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-25",
"last_updated": "2011-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AL",
"license": "21251",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "117354",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "511-01630",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mobile, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.