Island Medical Red Bay LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

ISLAND MEDICAL RED BAY LLC

Practice address

211 Hospital Rd
Red Bay, AL 35582-3858

Phone

(256) 356-8160

NPI assigned

Sep 26, 2017

Last updated

Sep 26, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Charles Wolf

Title

VP of Finance

Phone

(330) 656-5911

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1506384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506384000000",
    "number": "1649789249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92974",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441942974",
            "telephone_number": "877-716-2447",
            "fax_number": "330-656-5901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 HOSPITAL RD",
            "city": "RED BAY",
            "state": "AL",
            "postal_code": "355823858",
            "telephone_number": "256-356-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND MEDICAL RED BAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-26",
        "last_updated": "2017-09-26",
        "status": "A",
        "authorized_official_last_name": "WOLF",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "330-656-5911"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kelly Mauldin, M.S., CCC-SLP

• Emergency Medicine Physician in Red Bay, AL
• Providers in Red Bay, AL by specialty
• Emergency Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2017; 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.