Organization Active NPI

Dothan Spine & Specialty LLC

  • General Practice Physician
  • Dothan, AL
National Provider Identifier
1104282292
Registry record updated Apr 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
2089 Issued in AL
Legal business name
DOTHAN SPINE & SPECIALTY LLC
Practice address
412 N Foster St
Dothan, AL 36303-4545
Phone
(334) 793-1081
Fax
(334) 792-7600
NPI assigned
Jan 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul D Weeks, D.C.NPI 1346439619
Title
President
Phone
(334) 793-1081

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X 2089 AL Primary

Addresses

Primary practice location

412 N Foster St
Dothan, AL 36303-4545

Mailing address

412 N Foster St
Dothan, AL 36303-4545
Phone (334) 793-1081

Other identifiers 1

IdentifierTypeStateIssuer
529928260MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160322001859 AL Part B Supplier - Clinic/Group Practice 1557668365 Receives reassigned benefits from 7 practitioners
Practice locations: Dothan, AL

National Provider Directory

National Provider Directory

Locations

2970 Ross Clark Cir
Ste 1
Dothan, AL 36301
Phone (334) 305-0222

412 N Foster St
Dothan, AL 36303
Phone (334) 793-1081

1817 S Oates St
Dothan, AL 36301
Phone (334) 793-1081

2970 Ross Clark Cir
Ste 1G
Dothan, AL 36301
Phone (334) 793-1081

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492473600000",
    "number": "1104282292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 N FOSTER ST",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363034545",
            "telephone_number": "334-793-1081",
            "fax_number": "334-792-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 N FOSTER ST",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363034545",
            "telephone_number": "334-793-1081",
            "fax_number": "334-792-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOTHAN SPINE & SPECIALTY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-06",
        "last_updated": "2017-04-18",
        "status": "A",
        "authorized_official_last_name": "WEEKS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "334-793-1081",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "AL",
            "license": "2089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529928260",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.