NPIMap

Organization Active NPI

Eastern Shore Children's Clinic, P.C.

  • Pediatrics Physician
  • Spanish Fort, AL
National Provider Identifier
1447614854
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
EASTERN SHORE CHILDREN'S CLINIC, P.C.
Practice address
9603 Stagecoach Commercial Park Circle
Spanish Fort, AL 36527
Phone
(251) 928-0624
NPI assigned
Apr 12, 2016
Last updated
Apr 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

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

Authorized official

Name
Henry Elliot Lee
Title
Office Manager
Phone
(251) 928-0624

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

9603 Stagecoach Commercial Park Circle
Spanish Fort, AL 36527

Mailing address

PO Box 989
Fairhope, AL 36533-0989
Phone (251) 928-0624

Other identifiers 1

IdentifierTypeStateIssuer
4018429MedicaidAL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2117879Eastern Shore Children's Clinic9603 Stagecoach Commercial Park Circle, Spanish Fort, AL 36527ComplianceNov 28, 2026

National Provider Directory

National Provider Directory
Tax ID family
Eastern Shore Children's Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9797 Timber Cir
#A
Spanish Fort, AL 36527
Phone (251) 928-0624

Practitioners & affiliated clinicians

Practitioners 11

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": "1460419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650326400000",
    "number": "1447614854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 989",
            "city": "FAIRHOPE",
            "state": "AL",
            "postal_code": "365330989",
            "telephone_number": "251-928-0624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9603 STAGECOACH COMMERCIAL PARK CIRCLE",
            "city": "SPANISH FORT",
            "state": "AL",
            "postal_code": "36527",
            "telephone_number": "251-928-0624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE CHILDREN'S CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-12",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "ELLIOT",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "251-928-0624"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4018429",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spanish Fort, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.