Southeast Physician Network, P.C.
Organization Active NPI Hematology & Oncology Physician · Tuscaloosa, AL
NPI 1598090839 · NPPES record last updated Sep 10, 2019
Key facts
- NPI
- 1598090839
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Hematology & Oncology Physician 207RH0003X
- License
- 10900 (AL)
- Legal business name
- SOUTHEAST PHYSICIAN NETWORK, P.C.
- Practice address
- 1410 McFarland Blvd N
Tuscaloosa, AL 35406-2209 - Phone
- (205) 345-8208
- Fax
- (205) 345-8209
- NPI assigned
- Oct 5, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Shelby Sanford, MD
- Title
- President
- Phone
- (205) 345-8208
Other NPIs with the same Medicare PAC ID 1
Member organizations 1
Practitioners 62
-
Linda Anguiano, CRNP
-
Ellen Wills Ball, APN-FNP
-
Linda C Canterbury, CRNP
-
Michael Cappelli, M.D.
-
John H Chambers IV, CRNP
-
Steven Coppock, M.D.
-
Karen B. Draper, CRNP
-
John W Duffy III, MD
-
Ida B Dunn, CRNP
-
Howard Joseph Falgout, M.D.
-
Steven Galvez, CRNP
-
Alejandro Garcia, M.D.
-
Kelli Garrick, CRNP
-
Molly Jackson Gwin, CRNP
-
Katlin Nolan Hancock, CRNP
-
Hailey Hull Howell, FNP-C, RN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091026000423 | AL | Part B Supplier - Clinic/Group Practice | 0840337721 |
Receives reassigned benefits from 58 practitioners Practice locations: Demopolis, AL; Winfield, AL; Tuscaloosa, AL; Selma, AL; Northport, AL; Jasper, AL |
National Provider Directory
Locations
3500 Highway 78 E
Jasper, AL 35501
Phone (205) 387-0333
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician |
207RH0003X | 10900 | AL | Yes |
| Radiation Oncology Physician |
2085R0001X | 10900 | AL | |
| Urology Physician |
208800000X | 10900 | AL |
Addresses
Primary practice location
1410 McFarland Blvd N
Tuscaloosa, AL 35406-2209
Mailing address
1400 Afflink PL Ste 101
Tuscaloosa, AL 35406-2452
Phone (205) 345-8208
Other providers in Tuscaloosa, AL
- Southeast Hospice Equipment Company Inc
- Southeast Medical Group, P.C.
- Southeast Medical, Inc.
- Southeast Physician Network, LLC
- Southeast Physician Network, P.C.
- Southeastern Hearing Services, Inc.
- Southeastern Pain & Rehabilitation Physicians, PC
- Southeastern Plastic Surgery Assoc., PC
- Southeastern Plastic Surgery, LLC
- Southeastern Spine Specialists Inc
All providers in Tuscaloosa, AL · Hematology & Oncology Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.