DR. WALTER CLARK BOUTWELL MD NPI 1316908809

NPI Information

NPI: 1316908809
Provider Name: DR. WALTER CLARK BOUTWELL, MD
Classification: Pediatrics - 2080N0001X
Entity Type: Individual

Specialization: Neonatal-Perinatal Medicine

PECOS Registration: Yes

Address:
207 HUNTER TRL
PIKE ROAD, AL
ZIP 36064
Phone: (334) 657-7198
Get Directions

DR. Walter Clark Boutwell, MD is a neonatal-perinatal medicine pediatrics in Pike Road, AL. The provider is a pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. DR. Walter Clark Boutwell, MD NPI is 1316908809. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

207 HUNTER TRL
PIKE ROAD, AL
ZIP 36064-415
Phone: (334) 657-7198
Fax: (334) 272-4876

The NPI 1316908809 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/1/2006 and was last updated on 8/28/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080N0001X	Pediatrics	Neonatal-Perinatal Medicine	MD-014439-E	PENNSYLVANIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	C-04258	MEDICARE UPIN	CONNECTICUT
2	4630520	MEDICAID	MICHIGAN
3	001312743	MEDICAID	CONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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