NPIMap

Organization Active NPI

Willow Tree Pediatrics PC

  • Pediatrics Physician
  • Cullman, AL
National Provider Identifier
1407361108
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
19923 Issued in AL
Legal business name
WILLOW TREE PEDIATRICS PC
Practice address
2108 Al Highway 157
Cullman, AL 35058-0656
Phone
(256) 735-4632
Fax
(256) 735-4639
NPI assigned
Dec 5, 2017
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Dr. Heidi Blair, MDNPI 1538389457
Title
Provider/Owner
Phone
(256) 708-6143

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 19923 AL Primary

Addresses

Primary practice location

2108 Al Highway 157
Cullman, AL 35058-0656

Mailing address

1641 Edgewood St NW
Cullman, AL 35055-5739
Phone (256) 708-6143

Other practice location 1

409 2nd Ave NW
Cullman, AL 35055-2877
Phone (256) 735-4632

Other identifiers 1

IdentifierTypeStateIssuer
138096MedicaidAL

National Provider Directory

National Provider Directory

Locations

1167 County Road 437
#A
Cullman, AL 35055
Phone (256) 841-5958

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1407361108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1641 EDGEWOOD ST NW",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350555739",
            "telephone_number": "256-708-6143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2108 AL HIGHWAY 157",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350580656",
            "telephone_number": "256-735-4632",
            "fax_number": "256-735-4639"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "409 2nd Ave NW",
            "address_purpose": "LOCATION",
            "city": "Cullman",
            "state": "AL",
            "postal_code": "350552877",
            "country_code": "US",
            "telephone_number": "256-735-4632",
            "fax_number": "256-735-4639",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILLOW TREE PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-05",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "256-708-6143",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "19923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "138096",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cullman, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.