Provider Demographics
NPI:1730198169
Name:SPRINGER-GROSS, PATRICIA M
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:M
Last Name:SPRINGER-GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2086
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-2086
Mailing Address - Country:US
Mailing Address - Phone:256-351-9470
Mailing Address - Fax:256-351-9472
Practice Address - Street 1:1403 8TH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3349
Practice Address - Country:US
Practice Address - Phone:256-351-9470
Practice Address - Fax:256-351-9472
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15119174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF35086Medicare UPIN