Provider Demographics
NPI:1124231766
Name:PHYSICIANS MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL CENTER, LLC
Other - Org Name:PHYSICIANS MEDICAL CENTER CARRAWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DICESARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-502-6000
Mailing Address - Street 1:P O BOX 10288
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202
Mailing Address - Country:US
Mailing Address - Phone:205-502-5610
Mailing Address - Fax:205-502-5513
Practice Address - Street 1:2401 15TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35234
Practice Address - Country:US
Practice Address - Phone:205-502-5766
Practice Address - Fax:205-502-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty