DECATUR ENT ASSOC., P.C. (NPI# 1164487708) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164487708 |
| Entity Type | Organization |
| Organization Name | DECATUR ENT ASSOC., P.C. |
| Practice Address |
1218 13th Ave Se Decatur AL 35601-4307 |
| Practice Telephone | 2563556200 |
| Practice Fax Number | 2563556241 |
| Mailing Telephone | 2563556200 |
| Mailing Fax Number | 2563556241 |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2013-08-22 |
| Authorized Official Name | DR. SAGE KIN COPELAND (PRESIDENT) |
| Authorized Official Telephone | 2563556200 |
| Authorized Official Credential | M.D.,F.A.C.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207YX0602X |
Otolaryngology Specialization: Otolaryngic Allergy |
Allopathic & Osteopathic Physicians | ||
| Y | 207YS0123X |
Otolaryngology Specialization: Facial Plastic Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 529001940 | 05 | |
| AL | RAILROAD MEDICARE | CM6320 | 01 |
| AL | BCBS OF AL GROUP# | D380 | 01 |
| Street Address |
1218 13TH AVE SE |
| City | DECATUR |
| State | AL |
| Zip Code | 35601-4307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265413124 | Sage Kinney Copeland | Otolaryngology | 1218 13th Ave Se, Decatur, AL 35601-4307 | 2005-11-08 |
| 1215445937 | Shawna Marie Cadarette | Physical Therapist | 1218 13th Ave Se, Decatur, AL 35601-4307 | 2018-01-16 |
| 1851833776 | Sung D Kim | Physical Therapist | 1218 13th Ave Se, Decatur, AL 35601 | 2016-11-09 |
| 1871948935 | Frank Fischer | Hearing Instrument Specialist | 1218 13th Ave Se, Decatur, AL 35601-4307 | 2016-04-26 |
| 1982876520 | Randall Wilks | Audiologist | 1218 13th Ave Se, Decatur, AL 35601-4307 | 2008-03-24 |
| 1558342931 | George H Godwin IIi | Otolaryngology | 1218 13th Ave Se, Decatur, AL 35601-4307 | 2005-11-11 |
| 1295716975 | Kathryn Sulcer | Physical Therapist | 1218 13th Ave Se, Decatur, AL 35601-4307 | 2005-11-09 |
| 1760463632 | Benjamin W Light | Otolaryngology | 1218 13th Ave Se, Decatur, AL 35601-4307 | 2005-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376000679 | Monica Dawn Ross | Counselor | 106 Lee St. Ne, Suite C, Decatur, AL 35601 | 2019-02-23 |
| 1063950319 | Samantha Elizabeth Pickett | Nurse Practitioner | 1115 Beltline Rd Se, Ste 400, Decatur, AL 35601 | 2017-02-07 |
| 1497208250 | Beronica Goodwin | Home Health Aide | 1102b Suite #2 4th Ave Se, Decatur, AL 35601 | 2016-07-28 |
| 1770957177 | Xochitl Dupre | Obstetrics & Gynecology | 1874 Beltline Road Sw, Suite 105, Decatur, AL 35601 | 2015-11-23 |
| 1104224708 | River City Psychiatry, Inc. | Community/Behavioral Health | 115 Johnston Street, Se, Suite 202, Decatur, AL 35601 | 2014-12-12 |
| 1760882690 | Derrick Aaron Randolph | Registered Nurse | 1207 7th St S.e., Decatur/morgan Hospital - Parkway Campus, Decatur, GA 35601 | 2014-08-28 |
| 1427465434 | Martha Read | Family Medicine | 2208 Danville Rd Sw Ste A, Decatur, AL 35601 | 2014-07-22 |
| 1205242948 | Pure Heart Home Care of Alabama, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 107 B 14th Street Sw, Decatur, AL 35601 | 2014-07-02 |
| 1720492242 | Christopher John Phillips | Emergency Medicine | 1201 7th Street Se, Decatur, AL 35601 | 2014-06-12 |
| 1366794711 | Complete Dental Decatur LLC | Dentist | 1241 Point Mallard Parkway, Suite. 105, Decatur, AL 35601 | 2012-10-10 |
| Find all providers in zip 35601 | ||||
| Taxonomy Code | 207YS0123X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Facial Plastic Surgery |
| An otolaryngologist who specializes in facial plastic surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate was, but is no longer issued by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700042132 | Preston Leigh Imhof | Otolaryngology | 2675 N Decatur Rd, Suite 707, Decatur, GA 30033-6131 | 2008-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689082273 | Melanie L Petro, Md, LLC | Otolaryngology | 1995 Ves Trace Cir, Vestavia, AL 35216-1372 | 2014-07-27 |
| 1659637684 | Austin Adams | Otolaryngology | 2700 Highway 280 S Ste 300w, Mountain Brk, AL 35223 | 2012-04-04 |
| 1033413489 | Roger Carlisle Suttle Jr | Otolaryngology | 414 S 4th St, Gadsden, AL 35901-5215 | 2010-12-28 |
| 1649471012 | Carey Joseph Nease | Otolaryngology | 423 Medical Center Dr Sw, Fort Payne, AL 35968-3421 | 2007-05-31 |
| 1164599825 | Gustavo Adolfo Diaz | Otolaryngology | 411 N Section St Ste 5, Fairhope, AL 36532-2650 | 2006-11-29 |
| 1801989918 | R. Don Bryan, M.d. Pa | Otolaryngology | 1022 1st St North, Suite 203, Alabaster, AL 35007 | 2006-10-02 |
| 1235117607 | Jeffrey Scott Robertson | Otolaryngology | 2001 Providence Park, Birmingham, AL 35242-4680 | 2006-01-05 |
| 1023421468 | Alabama Ear, Nose & Throat Specialists, LLC | Otolaryngology | 302 Merchants Walk, Suite 100, Tuscaloosa, AL 35406-2290 | 2014-06-03 |
| 1275828659 | Imc Otolaryngology Facial Plastic & Reconstructive Surgery, P.C. | Otolaryngology | 3401 Medical Park Dr, Bldg 1, Suite 103, Mobile, AL 36693-3318 | 2011-06-14 |
| 1033357744 | Scott A. Charlton, Md, PC | Otolaryngology | 101 E Brunson St, Suite 102, Enterprise, AL 36330-2526 | 2009-02-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.