Active NPI
Maxie Wilson, DO
- Pediatrics Physician
- Tuscumbia, AL
National Provider Identifier
1235692203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- DO.3041
- Practice address
- 234 Keller Park Blvd
Tuscumbia, AL 35674-1417 - Phone
- (256) 381-6963
- NPI assigned
- Apr 8, 2019
- Last updated
- Mar 1, 2023
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | DO.3041 | AL | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | DO.3041 | AL | Primary |
Addresses
Primary practice location
234 Keller Park Blvd
Tuscumbia, AL 35674-1417
Mailing address
234 Keller Park Blvd
Tuscumbia, AL 35674-1417
Phone (256) 381-6963
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO.3041 | AL | MD | Hospitalist Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tennessee Valley Pediatric Associatesinc. | Pediatrics | Past | Accepting new patients |
| HH Health System - Shoals LLC | Past | Accepting new patients |
Interoperability endpoints
- maxie.wilson@xdr.hhchealthdirect.org
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Helen Keller Hospital
- General Acute Care Hospital
- Sheffield, AL
- NPI 1508952235
-
- Pediatrics Physician
- Tuscumbia, AL
- NPI 1043323439
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677628800000",
"number": "1235692203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "234 KELLER PARK BLVD",
"city": "TUSCUMBIA",
"state": "AL",
"postal_code": "356741417",
"telephone_number": "256-381-6963",
"fax_number": "860-679-4624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "234 KELLER PARK BLVD",
"city": "TUSCUMBIA",
"state": "AL",
"postal_code": "356741417",
"telephone_number": "256-381-6963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MAXIE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-08",
"last_updated": "2023-03-01",
"certification_date": "2023-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "AL",
"license": "DO.3041",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AL",
"license": "DO.3041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tuscumbia, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.