Eastern Shore Children's Clinic

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

EASTERN SHORE CHILDREN'S CLINIC

Practice address

150 S Ingleside St
Suite 7
Fairhope, AL 36532-1803

Phone

(251) 928-0624

Fax

(251) 928-0655

NPI assigned

Apr 3, 2006

Organization subpart

No

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

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

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.

• Eastern Shore Children's Clinic, P.C.

  • Pediatrics Physician
  • Spanish Fort, AL
  • NPI 1447614854
  NPD tax ID

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elizabeth Maureen Orr, M.D.

  • Pediatrics Physician
  • Fairhope, AL
  • NPI 1003108150

  Single Specialty

  Medicare reassignment NPD
• Natalie Brooke Carlisle, MD

  • Pediatrics Physician
  • Fairhope, AL
  • NPI 1972064400
  NPD
• Susie Fitzharris, MD

  • Pediatrics Physician
  • Fairhope, AL
  • NPI 1912958240
  NPD
• Janelle N Davis, NP

  • Pediatric Nurse Practitioner
  • Mobile, AL
  • NPI 1427669449
  NPD (past)
• Ashley Lauren Penn, CRNP

  • Acute Care Nurse Practitioner
  • Spanish Fort, AL
  • NPI 1730446071
  NPD (past)
• Warner M Wiggins, M.D.

  • Pediatrics Physician
  • Fairhope, AL
  • NPI 1558343400
  NPD (past)

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650326400000",
    "number": "1831151331",
    "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",
            "fax_number": "251-928-0655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 S INGLESIDE ST",
            "address_2": "SUITE 7",
            "city": "FAIRHOPE",
            "state": "AL",
            "postal_code": "365321803",
            "telephone_number": "251-928-0624",
            "fax_number": "251-928-0655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE CHILDREN'S CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2022-04-19",
        "certification_date": "2020-10-09",
        "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": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000810930",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Bay Counseling Center, Inc
• East Bay Medical PC
• Eastern Shore Anesthesia PC
• Eastern Shore Care Services
• Eastern Shore Care Services, P.C.
• Eastern Shore Chiropractic & Sports Clinic, Inc
• Eastern Shore Cosmetic Surgery PC
• Eastern Shore Ear, Nose & Throat Clinic, PC
• Eastern Shore Eye Care, PC (Eastern Shore Eye Care)
• Eastern Shore Gastroenterology, P.C.

• Pediatrics Physician in Fairhope, AL
• Providers in Fairhope, AL by specialty
• Pediatrics Physician in Alabama

• 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 enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.