| Abc Pediatrics West Llc | |
|
400 19th St E Jasper AL 35501-5416 | |
| (205) 936-8107 | |
| (205) 512-2548 |
| Full Name | Abc Pediatrics West Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 400 19th St E, Jasper, Alabama |
| Authorized Official Name and Position | Leah Varden Gann (CERTIFIED RN PRACTITIONER) |
| Authorized Official Contact | 2059368107 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abc Pediatrics West Llc 400 19th St E Jasper AL 35501-5416 Ph: (205) 936-8107 | Abc Pediatrics West Llc 400 19th St E Jasper AL 35501-5416 Ph: (205) 936-8107 |
| NPI Number | 1316714512 |
|---|---|
| Provider Enumeration Date | 12/07/2023 |
| Last Update Date | 12/07/2023 |
| Medicare PECOS PAC ID | 3678925344 |
|---|---|
| Medicare Enrollment ID | O20240118000612 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316714512 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Leah V Gann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780930826 PECOS PAC ID: 8325273972 Enrollment ID: I20131106001965 |
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