Provider Demographics
NPI:1003004284
Name:LIFESTYLE MANAGEMENT OF BIRMINGHAM, INC
Entity Type:Organization
Organization Name:LIFESTYLE MANAGEMENT OF BIRMINGHAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:205-949-1912
Mailing Address - Street 1:10 OLD MONTGOMERY HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6737
Mailing Address - Country:US
Mailing Address - Phone:205-949-1900
Mailing Address - Fax:205-949-1919
Practice Address - Street 1:10 OLD MONTGOMERY HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6737
Practice Address - Country:US
Practice Address - Phone:205-949-1900
Practice Address - Fax:205-949-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty