Arthritis Care of the Eastern Shore, LLC
Organization Active NPI Rheumatology Physician · Fairhope, AL
NPI 1972885945 · NPPES record last updated Sep 15, 2011
Key facts
- NPI
- 1972885945
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rheumatology Physician 207RR0500X
- License
- 12259 (AK)
- Legal business name
- ARTHRITIS CARE OF THE EASTERN SHORE, LLC
- Practice address
- 3 Medical Park
Fairhope, AL 36532-1804 - Phone
- (251) 928-8804
- Fax
- (251) 929-3067
- NPI assigned
- Sep 15, 2011
- Organization subpart
- No
Authorized official
- Name
- William F Sullivan, M.D.
- Title
- Owner
- Phone
- (251) 928-8804
Practitioners 2
-
Freda Rogers Smith, CRNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111024000643 | AL | Part B Supplier - Clinic/Group Practice | 4587837356 |
Receives reassigned benefits from 2 practitioners Practice locations: Fairhope, AL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician |
207RR0500X | 12259 | AK | Yes |
Addresses
Primary practice location
3 Medical Park
Fairhope, AL 36532-1804
Mailing address
3 Medical Park
Fairhope, AL 36532-1804
Phone (251) 928-8804
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000023997 | Medicaid | AL |
Other providers in Fairhope, AL
- Sean A Andrews
- Ansley Beverly, LLC
- Apt Fairhope LLC
- Arabella Health & Wellness of Fairhope Opco LLC
- Erin E Armstrong
- Ascendia Wellness Care
- William Michael Asher
- Ashton Dale Counseling Services LLC
- Tyler Winkler Atwell
- Christian Richard Augustin
All providers in Fairhope, AL · Rheumatology 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 15, 2011. 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.