Provider Demographics
NPI:1124590468
Name:ROSS BRIDGE MEDICAL CENTER PEDIATRICS, LLC
Entity Type:Organization
Organization Name:ROSS BRIDGE MEDICAL CENTER PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PURVI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-494-7337
Mailing Address - Street 1:7118 LAKE RUN CIR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7500
Mailing Address - Country:US
Mailing Address - Phone:813-416-6438
Mailing Address - Fax:
Practice Address - Street 1:3635 MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-6391
Practice Address - Country:US
Practice Address - Phone:205-494-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty