Provider Demographics
NPI:1164467817
Name:BIRMINGHAM MINIMALLY INVASIVE SURGERY PC
Entity Type:Organization
Organization Name:BIRMINGHAM MINIMALLY INVASIVE SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER GENERAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-833-6907
Mailing Address - Street 1:48 MEDICAL PARK EAST DR
Mailing Address - Street 2:STE 150
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235
Mailing Address - Country:US
Mailing Address - Phone:205-833-6907
Mailing Address - Fax:205-833-6987
Practice Address - Street 1:48 MEDICAL PARK EAST DR
Practice Address - Street 2:STE 150
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-833-6907
Practice Address - Fax:205-833-6987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529928520Medicaid
AL051003774OtherBCBS
AL=========OtherEIN #