Provider Demographics
NPI:1013378496
Name:BROOKWOOD WOMENS DIAGNOSTIC CENTER LLC
Entity Type:Organization
Organization Name:BROOKWOOD WOMENS DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-236-8249
Mailing Address - Street 1:2006 BROOKWOOD MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6878
Mailing Address - Country:US
Mailing Address - Phone:469-893-2000
Mailing Address - Fax:
Practice Address - Street 1:2006 BROOKWOOD MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 112
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6878
Practice Address - Country:US
Practice Address - Phone:469-893-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALI3773261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology