Provider Demographics
NPI:1053302497
Name:EASTERN MEDICAL SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:EASTERN MEDICAL SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:RONK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-838-3800
Mailing Address - Street 1:48 MEDICAL PARK DR E
Mailing Address - Street 2:SUITE 457
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3400
Mailing Address - Country:US
Mailing Address - Phone:205-838-3800
Mailing Address - Fax:205-838-3206
Practice Address - Street 1:48 MEDICAL PARK DR E
Practice Address - Street 2:SUITE 457
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3400
Practice Address - Country:US
Practice Address - Phone:205-838-3800
Practice Address - Fax:205-838-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529302120Medicaid
ALD694Medicare ID - Type UnspecifiedMEDICARE GROUP ID