1457609075 NPI number — BROOKWOOD PRIMARY CARE - HOMEWOOD, L.L.C.

Table of content: (NPI 1457609075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457609075 NPI number — BROOKWOOD PRIMARY CARE - HOMEWOOD, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKWOOD PRIMARY CARE - HOMEWOOD, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BROOKWOOD PRIMARY CARE - HOMEWOOD, LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457609075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4902 VALLEYDALE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-4613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-980-8099
Provider Business Mailing Address Fax Number:
205-980-2606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1817 OXMOOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMEWOOD
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35209-3505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-870-4030
Provider Business Practice Location Address Fax Number:
205-870-4083
Provider Enumeration Date:
08/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
WESLEY
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
REGIONAL CFO, TENET
Authorized Official Telephone Number:
404-265-5009

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com